17 replies to this topic

[steve_emt_68]

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.

[Arizonaffcep]

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.

[Captain ToHellWithItAll]

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.

[crotchitymedic1986]

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.

[WelshMedic]

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

[Captain ToHellWithItAll]

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.

[akroeze]

You carry 100mg of Morphine? :shock:

[craig]

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

[akroeze]

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

We only carried 30mg Morphine and 300mcg Fentanyl

[iMac]

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).