IM Morphine

[1badassEMT-I]

EZ-IO is your friend...
We don't even use IV's any more for codes, protocol says go strait to EZ-IO

Nice.... makes for fast access to get your cardiac drugs on..... we just got our EZ-IO about 5 months ago. I love them.

 

[ExpatMedic0]

It seems like a faster more efficient means of delivering the morphine vs IM. Any thoughts or feedback on the use of IO morphine via EZ-IO vs IM morphine?
I know its about the same as delivering it IV, but I am not sure how others will look at the delivery method itself. Is the doc and or the pt. going to look at you weird if you choose the IO method?

 

[Veneficus]

Even in Lange and as you said SJW maybe considered a SSR and MAO pg 1057 Chp 65

I posted that it was. I never suggested it wasn't.

However, it seems there is ample evidence as well as basic scientific understanding that while the effects of said drugs are likely to be potentiated, they do not produce an instant lethal effect.

You described your treatment with morphine in a way that eluded to a full arrest. You later qualified it was respiratory arrest, which is a known and not uncommon adverse effect of hypersensitive reaction to opioids. Aside from posting a nursing drug guide (not impressive to me in the least, there is a reason publishers simplify those guides and why nursing texts are not used for medical students) you used a reference I gave to you to repeat my position that SJW is a MAOI and that it can also have actions similar to an SSRI. I don't understand the point of citing that at all. But I have had a long day and I am tired.


MedicRob posted a extremely well written article which spells out multiple times that while there is an interaction with SJW and certain opioids among other meds, morphine was demonstrated not to be one of them. The only other reference I could find was to a link that was removed. We can only stipulate as to why.

You have attempted to point out that narcan is a competative antagonist to opioids and can be used as a reversal agent to the adverse effects of opioids, which I don't see anyone here arguing against, but you somehow see the need to keep repeating it.

There are many instances in medicine where causations were erroneously attributed to unrelated events. It is possible that you did give somebody who was taking SJW morphine and that patient had an adverse event, but that does not mean that it was the interaction between the 2 substances that precipitated it.

Using narcan to acutely reverse the effects of opioids in the prehospital setting is a recognized school of thought. It is not the only recognized school of thought. I have tried to present another perspective which has seemed to be viewed as a challange rather than an opportunity.

The style of your original post looked like trolling to me. after following several pages of this thread, unfortunately it seems to be a more and more accurate assessment. If you are purposefully posting outrageous or recurrant statements to foster antipathy among this forum for your enteratinment or that of your coworkers, that is trolling.

I have no doubt that you embrace your view of what makes a quality EMS provider, I think it safe to say you have come to a place that has a largely different culture and view of EMS. I think it also safe to say that your coworkers you are sharing this with probably have a similar view. Some people look for consensus to make themselves feel better, some look for confrontation, and still others look for unquestioning acceptance.

Many people here have made attempts to reach out. It takes a lot more to make it to my ignore list. Only one has ever done it. In my not always humble opinion (I have been around a few years too) it is not what you did yesterday, it is what you do today that determines the type of provider you are. But keep in mind, I have introduced my peers and superiors to this forum as well, and they are a much tougher crowd to impress than a station of US EMS providers. You could be causing real damage to the reputation and development of the "professional" group you represent. (aka EMTs and Paramedics)

There are many EMS providers who have a job. Most will always have a job. Only a few will have a future.

 

[Veneficus]

It seems like a faster more efficient means of delivering the morphine vs IM. Any thoughts or feedback on the use of IO morphine via EZ-IO vs IM morphine?
I know its about the same as delivering it IV, but I am not sure how others will look at the delivery method itself. Is the doc and or the pt. going to look at you weird if you choose the IO method?

I think it depends on what your treatment goal is...

Are you willing to penetrate not only the skin and deep facial planes, but also bone in a non sterile environment which carries a real infection risk to deliver small doses of analgesia?

Don't forget that while in the emergent setting an IO is not a sterile procedure, in an ICU it is and for a valid reason. In some patients, just like prehospital or ED IV starts, nonsterile IOs are removed and sterile ones inserted.

Using morphine IM allows you to potentiate the effects of the drug by slowing the rate of absorbtion. I don't see why it would be a first line choice for any other reason.

I would look at you wierd if you stuck an IO in a patient to give relatively small doses of analgesics. I would think you seriously underestimate the risks of deep penetration of foreign bodies. I would also be somewhat concerned about your judgement as to what you think was a reasonable use of invasive procedures that were designed to be used in the most seriously ill patients in less critical populations.

 

[ExpatMedic0]

Hey Ven,
Thanks for the feedback. The EZ-IO is a new tool for me.

EDIT: I decided to start a new thread about EZ-IO in the ALS section

 

[1badassEMT-I]

I posted that it was. I never suggested it wasn't.

However, it seems there is ample evidence as well as basic scientific understanding that while the effects of said drugs are likely to be potentiated, they do not produce an instant lethal effect.

You described your treatment with morphine in a way that eluded to a full arrest. You later qualified it was respiratory arrest, which is a known and not uncommon adverse effect of hypersensitive reaction to opioids. Aside from posting a nursing drug guide (not impressive to me in the least, there is a reason publishers simplify those guides and why nursing texts are not used for medical students) you used a reference I gave to you to repeat my position that SJW is a MAOI and that it can also have actions similar to an SSRI. I don't understand the point of citing that at all. But I have had a long day and I am tired.


MedicRob posted a extremely well written article which spells out multiple times that while there is an interaction with SJW and certain opioids among other meds, morphine was demonstrated not to be one of them. The only other reference I could find was to a link that was removed. We can only stipulate as to why.

You have attempted to point out that narcan is a competative antagonist to opioids and can be used as a reversal agent to the adverse effects of opioids, which I don't see anyone here arguing against, but you somehow see the need to keep repeating it.

There are many instances in medicine where causations were erroneously attributed to unrelated events. It is possible that you did give somebody who was taking SJW morphine and that patient had an adverse event, but that does not mean that it was the interaction between the 2 substances that precipitated it.

Using narcan to acutely reverse the effects of opioids in the prehospital setting is a recognized school of thought. It is not the only recognized school of thought. I have tried to present another perspective which has seemed to be viewed as a challange rather than an opportunity.

The style of your original post looked like trolling to me. after following several pages of this thread, unfortunately it seems to be a more and more accurate assessment. If you are purposefully posting outrageous or recurrant statements to foster antipathy among this forum for your enteratinment or that of your coworkers, that is trolling.

I have no doubt that you embrace your view of what makes a quality EMS provider, I think it safe to say you have come to a place that has a largely different culture and view of EMS. I think it also safe to say that your coworkers you are sharing this with probably have a similar view. Some people look for consensus to make themselves feel better, some look for confrontation, and still others look for unquestioning acceptance.

Many people here have made attempts to reach out. It takes a lot more to make it to my ignore list. Only one has ever done it. In my not always humble opinion (I have been around a few years too) it is not what you did yesterday, it is what you do today that determines the type of provider you are. But keep in mind, I have introduced my peers and superiors to this forum as well, and they are a much tougher crowd to impress than a station of US EMS providers. You could be causing real damage to the reputation and development of the "professional" group you represent. (aka EMTs and Paramedics)

There are many EMS providers who have a job. Most will always have a job. Only a few will have a future.

I have waited for this post. While you share your views as I do my own. I can honestly say you one tuff cookie. And I will take what you have posted to heart and look at my actions as well as others. I know who I am. You know who you are. Let it be and put this to rest. It is what is.