Posted by: medicblog999 | February 4, 2009

Anyone for Morphine?

Firstly an update on Mrs Medicblog. Shes still in hospital but has managed to escape surgery so far. The docs or now thinking she may have had a ruptured ovarian cyst or may have a chronic appendicitis. Still waiting to see what is happening but she seems a bit better and that’s all that matters, although analgesia has been a bit of an issue which brings me onto today’s post.

ampulesAs a paramedic, I have access to my own supply of Morphine for use when caring for patients in pain. It is completely up to me when I give it and how much I give. I don’t have to ask or check with anyone ,and personally the ability to relieve someones pain and discomfort is one of the most rewarding things of being a paramedic. 

Through my nurse training, I was constantly reminded of a famous quote by McCaffery (1968):

“Pain is whatever the experiencing person says it is, existing whenever he says it does”

This remains my belief today. If I am looking after someone and they state they are in pain and give a pain score above 5 (on a 0-10 scale) then I will look at analgesia of some sort (ranging from entonox through paracetamol and brufen and onto Morphine). If a patient is in obvious distress then it is straight to the Morphine every time, titrated to effect, however much they need to become comfortable.

As I mentioned in my last post, the care we had at our local A&E was brilliant, they got straight on to my wife’s pain and 43mg of Morphine later she was finally able to get some sleep. After 10 hours waiting for a bed on a surgical ward at a different hospital she finally arrived and the familiar story happened straight away. She told them that she was in pain and they arrived with oral tramadol and paracetamol, despite the fact that she had been vomiting for the last 3 days and was unable to tolerate even water. This was pointed out but was to no avail. The reply from the nurse when questioned:

“Ill have to have a word with the doctor and see what they say”

For the next 20 hours her pain score was never below 5. 

Maybe this is what I will find the most frustrating when I start doing some nursing shifts again. I have forgotten what it is like to have to go and check with doctors before I can do what I know is needed. I think I will find it immensely frustrating to go and tell a doctor that someone is in significant pain and not be able to just relieve their pain straight away.

I am very aware of the analgesic ladder and how you should start low down with the non-narcotics then work upwards until the right analgesic level is achieved. I am well aware that Morphine is not the solution to all pain and that sometimes some aspirin, or an antispasmodic like Buscapan works far better.

Reflecting on my own use of Morphine, I wonder if sometimes i may be too liberal and some people may get some Morphine who maybe could have gotten by on something not as potent. However, I would much rather that than have someone in pain and think that they are putting it on when actually they are screaming with the discomfort. 

I don’t really know where I am going with this one, as my thoughts are literally just coming straight onto the page without any real structure. I just get mad when someone I love is in pain and many hoops have to be jumped through to get some decent analgesia. I know sometimes the nurses will want to give something stronger, but the docs wont prescribe it, but I also know that some nurses will give 2 paracetamol and not the prescribed opiates because they think the patient doesn’t need them.

I’m glad I’m a paramedic. I am glad that I can look after my patients in a way that I know all of you would want to be looked after.

I think that’s my rant over with now.. Thanks, I feel much better.

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Responses

  1. […] Read the rest here:  Anyone for Morphine? […]

  2. Good to hear Mrs 999 is doing OK.
    As far as pain in the field goes, I too used to be conservative when it came to narcotics for pain control. 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.
    Then I got chemical burns following a bizarre horse riding incident. That’s a long story on its own but…
    After a reported 40mg of narcotic pain killers in the ER ( I was silly) I was still screaming when they changed my bandages. That was REAL pain.
    Now I look more at their faces than their numbers.
    Good topic and great post 999!
    Hope all gets better soon.
    Happy Medic

    • Chemical burns, Horse riding accident????
      That’s just crying out for a post all of it’s own!
      I look forward to reading that one.

  3. Good to hear that Mrs 999 is doing OK.

    Morphine is great. In hospital last summer with a really akward pneumothorax, I was encouraged to cough up some grot I had in my lungs after a pleuradhesion operation.

    As my chest hurt like hell each time I moved, I was grateful for the oromorph.

    Mind you, one afternoon I spent about three hours watching the ceiling go past!

  4. Glad the missus is doing ok 🙂

    As a newbie, I found it very encouraging that your trip to A&E was a good experience. Keep us updated!

  5. Having had to drag people with fractures to an ambulance and then drive them over endless speedhumps with hardly any pain relief, I really appreciate having a mediciation which will defintively work. One thing I did learn though was how to splint and pad properly.
    Where I work now, the clinical director wants us to address peoples pain. To do this we can give Morphine, Midazolam, Ketamine and Methoxyflurane. The use of pre-hospital analgesia is a win-win, better for the patient and a smoother less stressful job for the Crew. The drugs are safe with repeat obs and correct administration there is hardly ever a problem. Take care, Pete.

  6. Personally – I hate morphine, or rather the effect it has on me! However – a Uni friend who was a GP had started out training as an anaesthetist. He told me years later that the most important thing he had learned for his later career was the importance of a patient being as near pain-free as possible.
    On the other hand – when I broke my leg below the knee skiing, the inflatable splint was put on, I was loaded into a piste-basher and transported up to the top of the mountain (imagine front seat of a tractor!), transferred to a stretcher and into a cable car, taken down and transferred to an ambulance (at which point it was decided I was in too much pain to go to the local emergency unit, straight to hospital) which travelled 35 miles down to the valley round hairpin bends. In A&E I was assessed, ski gear removed (no, NOT cut off, it might have been Prada), X-rayed (trolley to X-ray to trolley), 1/2 plastered and transferred to the ward (well, the corridor, it was high-season and not just on the pistes). THEN there was some consideration of pain-relief. It was a nice little spiral fracture 4cm below the epicondyle – nice bit of metal-work sorted that, I went ski-ing the next year and then had the metal out (there was a loose screw that waggled enough to cause bother when I walked more than a few hundred yards). They kept asking me in Britain if I could still lift my foot. The answer was yes, and I still ski! Entonox – that’s for wimps!!!! But the offer might have been nice.


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