Welcome to EMT City
Register now to gain access to all of our features. Once registered and logged in, you will be able to create topics, post replies to existing topics, give reputation to other members, get your own private messenger, post status updates, manage your profile and so much more. This message will be removed once you have signed in.
Sign in to follow this  
Followers 0

Fentanyl vs Morphine

Posted · Report post

If a patient is already using a daily 75mcg Fentanyl patch wouldn't you want to continue with Fentanyl IV for pain control of a long bone fracture versus giving Morphine IV or am I missing something?

It just seems like going back to Morphine would be like putting out a forest fire with a syringe.

0

Share this post


Link to post
Share on other sites

Posted · Report post

Not a bad idea, but there are some providers who can't push Fentanyl...For instance in Arizona medic's can't push Fentanyl, only morphine. At which point I would expect I would need to push a higher dose.

0

Share this post


Link to post
Share on other sites

Posted · Report post

I think that if they are already on a fentanyl patch that they are going to want to add more fent but I think that they will be pretty tolerant of any additional fentanyl that you give them.

Adding morphine might be a good adjunct to the pain regimen.

But you can give more fentanyl than really morphine without worrying about their resp status.

I give a lot a fentanyl in the field so I'm sort of biased on fentanyl but if you do both then that's a better idea at least to me it is.

0

Share this post


Link to post
Share on other sites

Posted · Report post

I agree that anyone that is on a fentanyl patch daily, will have a high tolerance for any pain medication that you choose to administer, but you still have to worry about OD. I would remove the fentanyl patch, and continue with Fentanyl IV. Since it is shorter acting, you have less risk of OD, than you would with piling MS on top of the fentanyl and whatever other pain medications are already in their body. If you had a long transport time and the fentanyl wasnt working, you could then move on to the next med in your arsenal.

0

Share this post


Link to post
Share on other sites

Posted · Report post

I would not agree with removing the patch is this case. The patch provides a baseline analgesia that can be continued. Any further pain relief can be titrated to the pt's pain. Just remember that anyone in a lot of pain will need a lot of analgesia.

Using set protocols and medication dosages just boils down to cook book medicine. I have been known to give a pt 25mg of Morphine without problems, if thet need it, they get it. Period.

WM

0

Share this post


Link to post
Share on other sites

Posted · Report post

I can remember one burn patient a while back that took my arsenal of 200mg of demerol and 100mg of morphine before we got good steady pain control. Our transport time from the scene to the burn unit was about an hour. We went directly from the scene based on the burn and the helicopters not flying.

I RSI'd her before we left so I had a controlled airway. The burn center was the closest trauma center too so she got to the care she needed.

0

Share this post


Link to post
Share on other sites

Posted · Report post

You carry 100mg of Morphine? :shock:

0

Share this post


Link to post
Share on other sites

Posted · Report post

You carry 100mg of Morphine? :shock:

i can carry up to 100mg of morphine as well (it is only 10 ampoules), but i dont i generally carry 60mg, but then i replace it each time i use it.

stay safe

0

Share this post


Link to post
Share on other sites

Posted · Report post

i can carry up to 100mg of morphine as well (it is only 10 ampoules), but i dont i generally carry 60mg, but then i replace it each time i use it.

stay safe

We only carried 30mg Morphine and 300mcg Fentanyl

0

Share this post


Link to post
Share on other sites

Posted · Report post

Here unless there is a known allergy to Morphine in which case they get fentanyl, Morphine is all that is given for pain control (minus the random entonox case). As for removing the patch? I think it would be a situational thing. You have to evaluate the situation and see whether or not adding onto what the patch is already given, the right thing to do and/if you should titrate more meds on board. I'm thinking a lot of factors would come into play with this one (onset, relief, location etc etc).

0

Share this post


Link to post
Share on other sites

Posted · Report post

Mixing narcotics has far less predictable results than simply hyperdosing with a single narcotic. Therefore, I would be more inclined to stick with Fentanyl.

And no, I would not remove the patch for the "baseline" reason that WelshMedic mentions.

0

Share this post


Link to post
Share on other sites

Posted · Report post

Throw some penthrane in the mix as well...been having great results with it here!!! LOL :)

0

Share this post


Link to post
Share on other sites

Posted · Report post

If you know the specific amount of morphine a patient has taken, isn't there a formula for how you would adjust your dosage? I remember a doctor with a mostly full beer mug telling me...but I've forgotten...

(I know it doesn't apply to this scenario since the patch dose is uncertain).

0

Share this post


Link to post
Share on other sites

Posted · Report post

If you know the specific amount of morphine a patient has taken, isn't there a formula for how you would adjust your dosage? I remember a doctor with a mostly full beer mug telling me...but I've forgotten...

(I know it doesn't apply to this scenario since the patch dose is uncertain).

Yup! Just google "Narcotic Equivalency" and you will find lots of charts. There is even a web site that is fill in the blanks:

http://www.medcalc.com/narcotics.html

0

Share this post


Link to post
Share on other sites

Posted · Report post

Hello,

Fentanyl patches are in mcg/hr.

The ratio for MSO4:Fentanyl is 1:10 in general.

Cheers

D

0

Share this post


Link to post
Share on other sites

Posted · Report post

We use Fentynal here in the CCU if the serum creatinine is unstable for Morphine as the Morphine will damage the kidneys, so I would take that into account before I gave pain relief. I know there isnt a mobile lab out there in the field yet, but check into your patients history whether there is renal impairment before pushing morphine if you have fentynal as a substitute.

Just my two cents and just thought I would add it.

Scotty

0

Share this post


Link to post
Share on other sites

Posted · Report post

I agree that anyone that is on a fentanyl patch daily, will have a high tolerance for any pain medication that you choose to administer, but you still have to worry about OD. I would remove the fentanyl patch, and continue with Fentanyl IV. Since it is shorter acting, you have less risk of OD, than you would with piling MS on top of the fentanyl and whatever other pain medications are already in their body. If you had a long transport time and the fentanyl wasnt working, you could then move on to the next med in your arsenal.

DO NOT REMOVE THE PATCH !

any predominatly agonist opiate / opioid couldbe used for breakthrough / additional pain relief

0

Share this post


Link to post
Share on other sites

Posted · Report post

Hi,

learned not to remove the patch until needed (i.e. cause she got unconscious, etc.), like welsh said for the base line reasons.

The problem with mixing opiate/opioids is the receptor block. The fentanyl is blocking the my*1 rezeptor already (and much stronger due to the fact that it is much more my1 dependent)so the morphine will mainly go to the kappa1* rezeptor which is mainly responsible for the respiratory depression.

So more morphine mainly means a bigger risk for an respiratory problem, not necessary a good pain relief....

I woul consider using the analgetic effects for an very strong pain in this situation. For an normal pain relief going up with the fentanyl's dose seems sufficient for me.

* Couldn't find and do not know the right name in english..sorry.

Greetings,

Phil

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
Sign in to follow this  
Followers 0