MORPHINE or NO MORPHINE

[peachemt]

Male 60 yr has pacemaker/defib combo. 911 call of mild pain 2 on scale of 10 in chest. main call is for anxiety and shortness of breath.

EKG check good. BP good.

Patient wants transport to university hospital 45 minutes away. Apart of research study with Medtronic combo. Nearest hospital is 5 miles away.

Patient wants to be transported in "sitting" position in lieu of restraint carrier ambulance. trouble breathing when strapped. anxiety lessens when sitting or standing.

What do you do as an EMT?

Why would EMT give morphine to patient in this case?

[croaker260]

Male 60 yr has pacemaker/defib combo. 911 call of mild pain 2 on scale of 10 in chest. main call is for anxiety and shortness of breath.

EKG check good. BP good.

Patient wants transport to university hospital 45 minutes away. Apart of research study with Medtronic combo. Nearest hospital is 5 miles away.

Patient wants to be transported in "sitting" position in lieu of restraint carrier ambulance. trouble breathing when strapped. anxiety lessens when sitting or standing.

What do you do as an EMT?

Why would EMT give morphine to patient in this case?

Im an confused....

1- Define "EKG check good"? Hell , Define "BP good" becasue a BP of 100 Systolic may technically be good for an opioid, but paints a different picture than a BP of 160 systolic.

2- Define "restraint carrier ambulance"

3- Define "EMT" in your context, because in the US (with a few rare exceptions), an EMT wouldnt be giving morphine, or checking an EKG.

As a side note, while he may be part of the research arm of a medtronic study, if this is a BLS/ILS ambulance, the hospital 5 minutes away is likely the best option. Simply explain that with todays technology, the ER doc can converse with MEDTRONIC's study coordinator if nessessary, and further more arrange transport by an ambulance equiped to the ALS level.

If I was an EMT, I would not want to transport a chest pain patient 45 min away. Of course in some rural areas an EMT is the only option, Kudos to those EMT's.

One final comment:

911 call of mild pain 2 on scale of 10 in chest. Main call is for anxiety and shortness of breath.

A "little chest pain" is every bit as bad as "a lot of chest pain".

If you believe it is cardiac, an opioid is usually appropriate, some services favor fentanyl over MS. Nitrates as well, yada yada yada.

[AnthonyM83]

Male 60 yr has pacemaker/defib combo. 911 call of mild pain 2 on scale of 10 in chest. main call is for anxiety and shortness of breath.

EKG check good. BP good.

Patient wants transport to university hospital 45 minutes away. Apart of research study with Medtronic combo. Nearest hospital is 5 miles away.

Patient wants to be transported in "sitting" position in lieu of restraint carrier ambulance. trouble breathing when strapped. anxiety lessens when sitting or standing.

What do you do as an EMT?

Why would EMT give morphine to patient in this case?

What's the entire history, allergies, meds, vitals, focused history and physical exam on the chief complaint? All this would play into whether paramedic (not EMT) will administer morphine or other drugs.

I don't know what a "restraint carrier ambulance" is. The norm is for all patients to be transported in sitting position on the gurney (and almost always expected to be sitting position for shortness of breath). They can be strapped in without putting pressure on the chest (tighten waist, but not chest straps).

[peachemt]

scratch first report of BP

Sitting 206/110 taken 4 .4mg nitro, didnt dissolve. baby asp 2 . takes 1-2 20mg oxycontin for nerve damage caused from bypass treatment in jan/2000. coreg 12.5mg, imdur 90mg, .5mg ativan as needed, diovan 40mg, nitrostat .4, zocor 40mg

no allergies.

inject fracture stated at 15% in 2006 . medication cocktail of coreg has increase to 45% in 3 years

patient states that pain had sub-sided when ems services arrived. lessened anxious feelings in chest. breathing only deminish in sitting or flatt position. sat in captain chair for transport

What's the entire history, allergies, meds, vitals, focused history and physical exam on the chief complaint? All this would play into whether paramedic (not EMT) will administer morphine or other drugs.

I don't know what a "restraint carrier ambulance" is. The norm is for all patients to be transported in sitting position on the gurney (and almost always expected to be sitting position for shortness of breath). They can be strapped in without putting pressure on the chest (tighten waist, but not chest straps).

EMT-I responders

[AnthonyM83]

Going to need to complete results of focused history and physical exam.

Complete vital signs, EKG rhythm, 12-lead interpretation, O2 sat, BGL, Lung Sounds, background on the current chief complaint (OPQRST), pertinent negatives/positives, skin signs. What is an "inject fracture" and what does the percentage signify. Same with the coreg increase.

It would be irresponsible to decide on a course of treatment just with what we've been given so far. Give us a bit more.

[Diazepam618]

Is it's the patients own morphine, because at least where I come from emt's can't give morphine, and why don't they call the medic for chest pain?

[ERDoc]

I believe that inject fracture is supposed to be ejection fraction. OP, it seems to me like you have an issue with something that happened on a call. If this is the case, please come out and say so. It would help us give you more honest opinions and help us determine what other information we would need to treat the pt. Why is this in the funny stuff section?

[Kiwiology]

Is this a scenario you want us to solve or are you fishing for answers to something you saw or happened to you/somebody you know?

If it's the latter you won't find many people here willing to second guess and judge what others have done with limited information.

I'd want a complete medical history, 12 lead ECG, detailed physical exam and just because this guy "wants" to go to a particular hospital; well it dont work like that here, you go where we take you IF we think you need to go there in the first place.

For 2/10 chest pain I'd barely be inclined to give a tab of nitro let alone morphine.

[Adam Swartz]

Why is this is the "Funny Stuff" forum? Where are the Paramedics when needed? ;) ;) :rolleyes: :rolleyes: :rolleyes:

[tniuqs]

Why would EMT give morphine to patient in this case?

Just where can an EMT give MS to start with ?????

inject fracture stated at 15% in 2006 . medication cocktail of coreg has increase to 45% in 3 years

Wow that Coreg is magic stuff !

I think ERDoc has called this one right . .... another phishing expedition I suspect too.

Hint: Occupation:aspiring future ems

Edited May 18, 2009 by tniuqs