Posted by: medicblog999 | February 4, 2009

A Follow up to `Anyone for Morphine`

pain-scale

Happy Medic has made a comment on the last post, ‘Anyone for Morphine?’, which I thought I would quickly add to. He mentions that he used to be quite conservative when dishing out his analgesia and explains that :

“I think it came from a Doc in my past telling me I had made the patient so pain free he was unable to assess her knee injury”

He then goes on to say how his practice has changed with his experiences and now manages his patients pain in a totally different way.

There are a fair few paramedics out there that dont seem to ‘like’ giving out Morphine etc.I bet that if you asked most of them what would stop them giving a patient strong opioids when they are in apparent discomfort, a large proportion would come back with the statement:

” the doctor needs to be able to see where the pain is so that he can see what is going on”

This is a really common misconception. In the UK we are governed by the JRCALC (Joint Royal College Ambulance Liason Committee) PreHospital Guidelines. In the 2006 edition, under the section ‘Pain Management’, it clearly states that :

” there is no reason to delay the relief of pain becasue of uncertainty with the definitive diagnosis. It does not affect later diagnostic efficacy”

If you take into account the half life of Morphine, which is approximately 2-3 hours then pretty soon the effects of what we have given the patient pre-hospital will soon enough wear off so that if the doctors really wanted to see how much pain the patient is in then they wont have that long to wait (although I cant ever imagine this happening these days……hopefully!)

Personally, I think this is a humanitarian concept. If I can relieve someones pain, then I will do it, to the best of my abilities. I have never had a complaint from a local A&E stating that I have made someone too comfortable, but I have heard some complaints about paramedics not giving analgesia when it is clearly indicated.

Im sure there is easily two sides to this discussion. There may be some of you reading out there who think that I am wrong in the way I manage pre-hospital pain, but ultimately, in this job, you need to be able to look back on your day and the jobs you have done and know that you have done the very best for your patients that was possible. Including trying to get their pain under control.

Thanks to Happy Medic for starting my mind going!

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Responses

  1. I’m all for decent analgesia. I too am sick to death of patients being denied decent pain relief just because certain paramedics are too scared to give it. The whole “It might mask the pain” crap doesn’t wash with me. We can make a real difference to alot of people who call us, taking away or easing someones pain is a big part of our job. I’d like to see more of an option with regards to pain meds such as fentanyl, intranasal diamorph and ketamine (this has been agreed that it is safe for paramedics to give, it’s not even a controlled drug!)
    I often use morphine and like you, haven’t been criticised for making a patient too comfortable.

    • Hi StreetMedic.
      I see that often too. I was just trying to be politically correct in my post. You can easily tell the Paramedics who are ‘scared’ to give it out. I think it mostly has to do with just being unfamiliar with it. Morphine has the fear factor about giving it. Another thing I see alot of is patients who have had fractured NOFs etc, only getting 2.5mg Morphine, beacuse they are old and might not take the effects well.
      Its a simple thing to do and its called titrate to effect! We all have access to naloxone, so whats there to be afraid off? I have never had to give naloxone for morphine administration. if I have a 85 yr old patient with a NOF and she has already had 10mg morphine (titrated to effect) but still has a pain score of 7, she will get some more (as long as resps and conscious level remain fine).
      Youve got me on my soap box now!!
      Thanks for the comment.

  2. Personally, I think this is a humanitarian concept. If I can relieve
    someones pain, then I will do it, to the best of my abilities. I have
    never had a complaint from a local A&E stating that I have made
    someone too comfortable, but I have heard some complaints about
    paramedics not giving analgesia when it is clearly indicated. i think so
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