EMS Patient Care Advocate
Forum Lieutenant
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It's not inappropriate per se, but it does get kind of tiresome when we have debates over rather simplistic things.
Ok, I will back off. Makes sense. Sorry
It's not inappropriate per se, but it does get kind of tiresome when we have debates over rather simplistic things.
Ok, I will back off. Makes sense. Sorry
It isn't a huge deal if there is an honest question, but I know several of the more prominent members of this forum have commented that you tend to start threads over anything you hear about (or so the perception is). Personally, I have no serious problem with it- so long as you are judicious and receptive to constructive criticism- but you should be aware of how others perceive these threads at times.
Nasal Fentanyl FTW
you were able to get an 18g, would u still go nasal vap ?
I would give the IN dose prior to, or at the same time as obtaining i.v. access.
Is there any concern giving morphine when you cannot obtain a BP due to peripheral site being burned?
If I have a protocol allowing (or can get an order for) a diphenhydramine chaser with morphine administration, I'd absolutely do it. AFAIK, we don't have access to other opiates out here (yet?) for pain control. :wacko:Just chase it with diphenhydramine. Most of the hypotension associated with morphine is due to the associated histamine release. Diphenhydramine is an effective way to minimize the risk of it. Besides, you'll be obtaining vascular access so any hypotension is easily corrected.
AFAIK, we don't have access to other opiates out here (yet?) for pain control. :wacko:
We can't do conscious sedation, but we can RSI. My plan for major burn patients is to give them the max doses of fent and versed and RSI. It is the only humane thing I can do if there burns are bad.
The few burn patients I've seen have required a lot of narcotics for adequate pain control. The last emergent burn patient I saw (flown in, I was on ground transport for the short ride from the pad) got 350 mcg fentanyl and that still wasn't enough. And yes, the patient was still breathing at a normal rate and depth. Good SpO2 if I recall... Fortunately, no airway involvement. This was about 8 years ago.Honestly, my take on anything approaching serious burns is that it's an indication for ketamine with or without intubation. Nothing short of aggressive dose of narcotics coupled with good sedation or flat out dissociation is adequate for pain control in these situations.
I just double checked our meds list out here and nitronox, fentanyl, ketamine... all still not on the list. We do have morphine and midazolam though. Diazepam was removed from the list several years ago. Our morphine max dose is 30 mg, in 10 mg increments q 5 min titrated to effect - for burns. For other trauma types, we can max-out at 20 mg, given in 2-5 mg increments q 5 min as long as there's no head or torso injury, GCS 15, and BP >90 for each incremental dose.No fentanyl? That's crazy. If you didn't have another narcotic option besides morphine and really were uncomfortable giving it I'd go for nitronox. Sure it's not nearly as strong, but something is better than nothing...
We have Fentanyl 1-2 mcg/kg max single dose of 100 mcg either IV or IN with a total max dose of 300 mcg IV or 2.5 mcg/kg IN and then can call and get orders for more if we really need it. Second option is morphine 2-5 mg IV q 15 mins no max. Intermediates (me until I finish school) have nitronox provided it isn't contraindicated.
Our medical director is pretty liberal about pain management.