#HM12DoC 10mgs of Morphine

On the 10th Day of Christmas Happy Medic gave to me…

10mgs of Morphine

9 Homeless Psychs

8 Asthma Attacks

7 OBs Crownin’

6 Priapisms

5 Golden hours

4 Fibbing V-Fibbers

3 Tripple Os

EMS 2.0

and a British Medic dressed in green
Pain management pre-hospital falls into two categories: Those who know what pain is and those who don’t.

I’ve spoken here before about my burns and how I was almost willing to jump off a cruise ship to get some pain medication, and we have linked extensively to the articles from Rogue Medic, who reminds us that 2mg of Morphine + severe pain = Severe Pain.

If you are considering dosing a person based on a complete assessment, you have to qualify their 10 out of 10 in THEIR terms, not yours.  That being said, we also become better care givers when something that we treat happens to us.

As a young paramedic I too dosed low on burns until I was burned.  I rarely padded backboards until I ended up on one.

On a recent job a rather large man fell out of bed and injured his hip.  On the 5th floor and the elevator is out of service.  Groan.  After a complete assessment and another look at the staircase, it was decided by the ambulance crew to “Dose and Go.”  as one partner went downstairs to get the narcotics from the onboard safe, the other was on the phone to medical control.  we are required to get permission to dose more than 20mg and she was already thinking ahead to the staircase.

After dosing an initial 6mg we began to package.  Soon after a reassessment another 4mg and the next 10 was already in the medic’s shirt pocket.  As we began the downward trek and the truck company was earning their money, our patient was in extreme discomfort.  Another 5 and 5 followed quickly and downstairs finally the EMT had another 10 loaded and ready.

The man was in extreme discomfort but not searing pain which he would have experienced had we followed a standard, by the book, treatment plan of 2mg, 2mg, 4mg etc etc.  By thinking ahead and knowing your protocols you can make a huge difference in someone’s experience.

This Christmas, I want you to think back to a time in your life when you were in extreme pain and imagine that instead of taking the pain away someone rubbed your back and told you it will be OK.  It kind of helps, but what really helps is a chemical reaction in the body that numbs the pain for real.

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6 thoughts on “#HM12DoC 10mgs of Morphine”

  1. Recently the ‘pleasure’ of the trauma QA guy was bestowed onto me. It is amazing how many patient’s with distressing to severe pain go untreated. Granted we still operate in a medical control only system for narcs (statewide by regulation) but many people don’t even ask the physician. Then some people get defensive when you question why a patient with a documented obvious fracture and “10” out of 10 pain didn’t get any management during the hour of patient contact and 15-20 mile transport to the trauma center.

    The last trauma patient I had got every last bit of fentanyl in my lockup (a whopping 200 mcg), the last 50 mcg of which was just outside the ED door before going into the trauma bay where he’d be receiving the trauma team sadist special (one finger welcome, foley, and orthopod manipulation from hell, etc.)… I got looked by some of my peers like I committed a mortal sin especially when I said I’d have given this poor soul more if I had it.

    My supervisor heard about it and thankfully asked our medical director why we couldn’t carry more or give fentanyl and/or morphine under circumstances where physician contact is not practical or possible. Now we are set to have a communication failure order for pain and at least double our complement of opioids.

    We just need to find a way to educate everyone the simplest of thoughts: what would you want if it was you? Sometimes it’s easy to be blinded by the monotony of the job, dissatisfaction with the workplace, or desire to be doing something else. We should never forget we’re treating other people. It’s an awesome job considering some of the tools at our disposal and the little and big differences we can make in others’ lives.

  2. Recently the ‘pleasure’ of the trauma QA guy was bestowed onto me. It is amazing how many patient’s with distressing to severe pain go untreated. Granted we still operate in a medical control only system for narcs (statewide by regulation) but many people don’t even ask the physician. Then some people get defensive when you question why a patient with a documented obvious fracture and “10” out of 10 pain didn’t get any management during the hour of patient contact and 15-20 mile transport to the trauma center.

    The last trauma patient I had got every last bit of fentanyl in my lockup (a whopping 200 mcg), the last 50 mcg of which was just outside the ED door before going into the trauma bay where he’d be receiving the trauma team sadist special (one finger welcome, foley, and orthopod manipulation from hell, etc.)… I got looked by some of my peers like I committed a mortal sin especially when I said I’d have given this poor soul more if I had it.

    My supervisor heard about it and thankfully asked our medical director why we couldn’t carry more or give fentanyl and/or morphine under circumstances where physician contact is not practical or possible. Now we are set to have a communication failure order for pain and at least double our complement of opioids.

    We just need to find a way to educate everyone the simplest of thoughts: what would you want if it was you? Sometimes it’s easy to be blinded by the monotony of the job, dissatisfaction with the workplace, or desire to be doing something else. We should never forget we’re treating other people. It’s an awesome job considering some of the tools at our disposal and the little and big differences we can make in others’ lives.

  3. I would have just about sold my soul to have had some pain relief available when I dislocated my patella 3 hours into an 8 hour transatlantic flight – and even more so when a lovely, kind orthopaedic surgeon put it back into place without any pain relief …

  4. I would have just about sold my soul to have had some pain relief available when I dislocated my patella 3 hours into an 8 hour transatlantic flight – and even more so when a lovely, kind orthopaedic surgeon put it back into place without any pain relief …

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