The Ultimate Wacker Kit (no Joke) 5k Spent On It

[spenac]

10mg IV is an appropriate dose for many people. While many providers (docs, nurses, medics) get the idea that any more than 5mg of morphine will stop your breathing and kill the patient and revoke your paramedic license and reprogram your DVR and spook your pets, multiple studies in adults and children have demonstrated the safety and efficacy of 0.1mg/kg of IV morphine for pain relief. So she's right, 10mg is a dose. An appropriate dose meant to reduce pain, not a homeopathic dose meant to make the provider feel better.

'zilla

Doc I will argue on this point. I realize many patients can handle a larger dose. I actually almost always start at the 5mg if they are basically healthy then titrate to relief. Surprisingly many fall asleep with just the 5mg. Guess what I've hate to bag patients with only 5mg in them while I got it reversed. Apparently this is pretty common as even the ER doctors etc seem to start small and titrate to relief rather than going big and having to take over airway. I am a firm believer in pain relief and I do make sure my patients feel no pain, but I do it in small amounts every few minutes. I do realize odds are 10mg will not kill. I do hate the providers that stop with just the 2-5mg when the patient is still in pain. And 300mg is still no that much in the big picture. Say he gets hurt no medical help availble to fix broken leg, it only buys him 30 injections of pain meds per your math. So in just a few days he will have no relief The problem you bring up is errors. That could occur with just as many over the counter meds.

Sorry you just lost you TV provider so you no longer have to worry about the programming.

[Chief1C]

Once they give the wrong dose and he starts talking like a zombie, they'll kill him anyway, so what's the difference?

[tinman694]

You mean that amonia inhalants aren't some 'miracle cure' for unconciousness???

Ammonia inhalants are a wonderful tool if used to the proper effect.

If the feds (or a state entity) wanted to whack a whacker, they could easily by just the possession of the sterile water (Prescription Required!)

WTF-O

Does he have a fully strobed, light bar equipped response vehicle as well----just in case?

Sure we could all pitch in and get him a Que to 'fully outfit' the set up

This is what I missed after being away from the fray for almost a year!

[Scaramedic]

Ughh, where to start?

First off the amount of Morphine a pt can handle is based on a ton of factors. Are they chronically on MS? I once had a Chronic Pain pt on 400mg of MS a day. Do you really think 5mg is going to affect this pt in the least? Are they in a great amount of pain? Burn victims can require large doses of MS. To simply say that the dose should be 5-10 is wrong and feels an awful lot like cookbook Medicine.

$5K???? I could put together a kit like that for the cost of the bag and maybe a few hundred more just by 'procuring' what I need. Only someone NOT in the field could spend that much money.

Laryngoscopes, ET's and BVM's??? Oh My!!!!

So it's the end of the world and Randy Rescue is going to intubate patients, then what? Bag the patients until they rebuild the hospitals? This is the problem with the 'survival nut' culture. They spend too much time preparing for the worst and then forget that without modern technology most of their stuff is useless. In a REAL world scenario if you need a vent in major disaster you probably are going to die. We will not be working arrests in a world ending scenario. Hell, I won't be working period. I'll consider a meteor impact my two weeks notice and I'll take my chances with the rest of the wandering hordes.

[spenac]

Ughh, where to start?

First off the amount of Morphine a pt can handle is based on a ton of factors. Are they chronically on MS? I once had a Chronic Pain pt on 400mg of MS a day. Do you really think 5mg is going to affect this pt in the least? Are they in a great amount of pain? Burn victims can require large doses of MS. To simply say that the dose should be 5-10 is wrong and feels an awful lot like cookbook Medicine.

Note the titrate to relief. I would rather not compromise my patients respiratory system. So start with 5mg healthy and honestly even most severe pain paeople are fine after that dose, and it has caused respiratory depression, so was actually to much on some. If not out of pain in less than 5 minutes later I push more. Yes I understand some people could need a ton to get effect. I also understand that I may need to bust out one of my other pain killers. But again you have helped prove my point 300mg is not an extreme amount. My only problem is his lack of education.

[Dustdevil]

Laryngoscopes, ET's and BVM's??? Oh My!!!!

So it's the end of the world and Randy Rescue is going to intubate patients, then what? Bag the patients until they rebuild the hospitals?

That's for all the narcotics overdoses he's going to be having off all those narcs!

[zippyRN]

That his service either doesn't have many ambulances contrary to his claim or he is unaware of how many vials it takes to add up to 300mg of morphine.

Maybe he will reconsider because if you have morphine on the ambulance you need at minimum 2 vials. A lot of ambulances brings to my mind more than 20 ambulances. So there should be at minimum levels per ambulance a total of 400mg of morphine if they are all together.

Also just showing it's not as much as some claim. So really 300mg is not a big deal.

morphine sulphate injection comes in (rightpondia) in 10 mg/ 1ml ampoules usually, - thereare larger ampoules / stronger solutions avaialble but from the point of view of the pre-hospital practitioner or theED it comes in 10 mg ampoules.

I currently work 'in real life' on a regional tertiary specialist rehab unit - we don't use alot of morphine - but we keep 100 -200 mg of morphine sulphate injection in our Controlled Drugs cupboard aswell as a small amount of diamoprhine, and morphine oral solution and controlled release tablets , similar amount of oxycodone, plus 100 mg or so of midazolam and apacket or two of temazepam ( as these benzos are sch 3 CDs inthe Uk and require the same storage as the Sch2 or treated as Sch2 opiates)

in the ED or on the Acute Assessment Unit 300 -500 mg of morphine sulphate injection was pretty typical stock holdings ... plus all the rest and bearign in mind that asit was rightpondia we were also holding diamorphine and in the ED injectable fentanyl and alfentanil

300 on an ambulance is probably excessive unless you have very liberal dose guidelines and/or very long transports

60 -100 is probably more realistic - allowing you to treat somewhere between3 and 10 patients before having to restock

[spenac]

300 on an ambulance is probably excessive unless you have very liberal dose guidelines and/or very long transports

We have very long transports. Plus just as easy to lock the supply of morphine in the ambulance as it is to lock up at the station.

[Ghettomedic351]

Ughh, where to start?

First off the amount of Morphine a pt can handle is based on a ton of factors. Are they chronically on MS? I once had a Chronic Pain pt on 400mg of MS a day. Do you really think 5mg is going to affect this pt in the least? Are they in a great amount of pain? Burn victims can require large doses of MS. To simply say that the dose should be 5-10 is wrong and feels an awful lot like cookbook Medicine.

Well Sir I beg to Differ on your "Cookbook Medicine" analogy. Cookbook medicine is where you simply do something because your "cookbook" says to do it that way. While people who do have chronic pain might require more than your stated 5mg, in the 21st century we have these really cool things call radio's which we can contact an actual physician and see if a higher dose would be prudent. As far as morphine and burn patients I think you should be careful to avoid the effect of the peripheral vasodilation which occurs,in that case a synthetic such as fentanyl might be more suitable or perhaps a little versed.

[EMS49393]

Paramedic: “Hello Sir. What seems to be the problem today?”

Patient: “I fell, and I’m pretty sure I broke my arm. It hurts so badly. It’s the worst pain I’ve ever had.”

Paramedic (following standard physical exam): “Yes sir, that arm certainly looks like it hurts you. Are you allergic to anything?

“No.”

“Do you take any routine medication or have any medical problems?”

“No. I’m very healthy, if it wasn’t for losing my footing on that truck bed, I’d still be up there shoveling gravel onto the roadway. I work out three times a week. What am I going to do if my arm is in a cast?”

“Well, I’m sure there are alternative ways of exercising if that is the case. Let’s worry about your pain.”

“Good idea, I’m telling you, this arm is killing me.”

“Sir, you’re in luck. I’m going to start an IV while my partner is hooking you up to the monitor and putting this on your finger (shows pulse ox probe). You’re in good hands. I’m not going to give you just 5 mg of Morphine, or even 10 mg. We have a three hour ride to the ER. You’re going to get 300 mg of Morphine. Call me the candy man. While you’re calling people, call me a lawyer. I’m going to need one for the narcotic overdose I’m going to give you.”

Meanwhile, the EMT is diligently setting up intubation equipment and pulling the boxes of Narcan off the shelves. Although his is angered by the notion that he will have to spend at least one of his days off in court, he is safe in the knowledge that this will be the last time he ever has to work with this cowboy paramedic.