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Old 02-25-2011, 07:22 PM   #1
18G
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Demerol - Anyone Still See It Used?


Had an IFT the other day where an elderly pt. was being transported due to a fractured hip. Patient was having considerable pain and had received initial dose of 100mcg Fentanyl on arrival at the ED and then subsequent doses of Demerol 25mg... I wasn't real impressed with the pain management... I mean 25mg of Demerol is a very low dose for pain of this magnitude let alone using Demerol at all.

I haven't seen or heard of Demerol being administered in ages so was surprised to see that the CRNP decided to use Demerol when there are much better analgesics available.

Patient did well for most of the transport up until about 15mins out he experienced increased pain... I noticed he stopped having conversation, was moving around on the stretcher trying to ease the pain, and had a noted grimace and complaint of increased pain from level 5 to a level 8 pain. He stated, "the last dose definitely wore off". At this point the Demerol was onboard for about an hour.

Prior to departing I had talked to the CRNP about orders for Fentanyl she said if at all possible to hold off due to the recent admin of the Demerol. Patient was obviously in pain which was also being exacerbated from ambulance transport. I gave fentanyl 100mcg. Within a minute, the patients pain response was gone, pt. was conversing again, and no longer moving around. Pt. stated much relief with pain rating back down to the tolerable level 5.

I have read that quite a few hospitals have really gotten away from Demerol due to the side effects and much better alternatives.

Are there any hospitals or EMS systems still routinely giving Demerol?



Last edited by 18G; 02-25-2011 at 07:29 PM.
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Old 02-25-2011, 07:57 PM   #2
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maby that hospital wont let an NP use anything better than demerol...

In my area the PA/NP cant prescribe any more than 1mg dilaudid before calling the MD

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Old 02-25-2011, 08:15 PM   #3
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The initial dose of pain med was fentanyl (100mcg) when he first arrived at the ED... patient said it made him feel kinda loopy so not sure if that's why she changed or not. My reassessment after the fentanyl I gave did not reveal the loopy feeling pt. experienced from initial dose.
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Old 02-26-2011, 07:59 AM   #4
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The hospitals around here use it VERY rarely. We don't carry it. To be honest, the last time I transferred a patient who'd been given demerol was so long ago I don't even remember how well it worked for them.
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Old 02-26-2011, 03:03 PM   #5
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I dislocated my knee and was given Demoral before they put it back.

I was not impressed!
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Old 02-26-2011, 07:43 PM   #6
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The nurse wanted to give me IV Demerol after surgery once, I told her no. She insisted and kept bothering me, I finally said yes, just to get her to leave me alone. But, I had warned her not to. I had half the dose and I promptly threw up all over her, me, and the floor. I finally got to say "I told you not to give me Demerol"
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Old 02-26-2011, 08:02 PM   #7
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Demerol has a whole bagful of nasty side effects, toxic metabolites, and supposedly mediocre pain relief compared to morphine. Not to mention, according to our local seekers, it gives the best "high", especially when mixed with phenagren to combat vomiting (one of the aforementioned side effects).

Most hospitals have eliminated it from formulary for these reasons.
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Old 02-26-2011, 10:55 PM   #8
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Quote:
Originally Posted by usalsfyre View Post
Demerol has a whole bagful of nasty side effects, toxic metabolites, and supposedly mediocre pain relief compared to morphine. Not to mention, according to our local seekers, it gives the best "high", especially when mixed with phenagren to combat vomiting (one of the aforementioned side effects).

Most hospitals have eliminated it from formulary for these reasons.
It really depends on the Pt.

Morphine has no effect on me, but Demerol will knock me out. My daughter is the same way. Morphine provides no pain relief, but Demerol works great on her.
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Old 02-27-2011, 06:45 AM   #9
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Our network does not use it.


How much did your pt weigh?
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Old 02-27-2011, 07:00 AM   #10
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I've seen my local ED use it. We don't on the trucks as we have a whole handful of other pain killers to go for (Nubain, MS, Fent, Dilaudid.)
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