Pain Control Question

[mrsbull]

I am not sure. What do you consider an "allergic reaction?" I go by the literal definition relating to an immune response involving immunoglobulin E (IgE) mediation of mast cell and basophil activation among other mechanisms as the proper way to define an allergy (when considering anaphylaxis). Most everything else will fall under the umbrella of an adverse reaction.

From evidence I have seen, postoperative complications including puritis, nausea/vomiting, and urinary retention in patients on PCA were significantly higher in morphine groups compared to fentanyl groups. Therefore, I could say with some confidence that the incidence of adverse reactions may be lower overall in patients who receive fentanyl.

Take care,

chbare.

I did not clarify "sorry I thought I had". I put a reaction (sensitivity/adverse) to the drug instead of an allergy. Personally when I refer to an "allergy" I think shut down time anaphalaxis a TRUE med emergency. Not a ohh I am sensitive to something.

I hear a lot of pts when doing my SAMPLE in my A part, what is the reaction that xyz does to you. If you say itching well that sounds (to me) like a sensitivity. My DD is allergic to Rocephin. It is not pretty. Now if a pt says I am allergic to penacillin and your reaction is you stop breathing then OK fair nuff that will HAVE to be relayed to the intake facility.

Does anyone put a sensitivity to a drug on a pcr or only TRUE allergies??

[Kiwiology]

Most people will tell you they are "allergic" to something when they mean they get anything from a tummy upset to bit of a rash to anaphylaxis.

I generally write the degree of reaction eg "rash" or "nausea" etc next to the med name.

[melclin]

I was just reading up on the Fentanyl/Morphine post. Without bringing it back to light. I have a few questions.

I am an NREMT-B so please bear with me. I know fentanyl is a quicker acting pn med. Morphine is a longer acting drug.

What other than what I have just stated above is different about them?

Why would you give someone one or the other??

What would your Criteria be? ie b/p, resp rate, MOI/NOI

Is it a personal choice or is it a Med Dir thing?

Also what is the difference between the 2 mentioned above and Demerol?

I ask because these are the most commonly talked about narcs available to EMS personnel? This is not related to any study I am doing just personal knowledge. Thanks for taking the time to respond. I hope I have asked these questions in a manner that is easy to understand. It is late here and I am getting sleepy.

I only skipped through this thread, but there are also some arguments out there that suggest that Fentanyl is better for certain types of pain than morphine and vice versa, but I think evidence for this is largely anecdotal.

The criteria for analgesia is pain. End of story. I can't stand seeing some of these guidelines you blokes have over there..."if pain score >7 contact medical control for 2mg of morphine".

Something worth mentioning about fentanyl is that it is highly lipid soluble and can be absorbed through nasal mucosa. So in the event of a difficult/delayed/impossible IV access, atomizing fentanyl up the nose is a good option. We have that option here, largely because we created our own evidence base for it. One of those professional things, building a discipline specific evidence base and all .

Also on the list of uses, is in break through pain in chronically painful conditions..cancer etc.

It can also be given in anesthetic doses without the haemodynamic effects of an equivalent dose of morphine for procedural sedation/analgesia (Synchonised cardioversion, RSI etc).

Demerol I don't know anything about. Its use is very limited here because of some nasty interactions and we certainly don't use it.

"It has no proven advantage over other opioid analgesics and there is significant potential for iatrogenic problems with its use."

-USE OF PETHIDINE FOR PAIN MANAGEMENT IN THE EMERGENCY DEPARTMENT - A Position Statement of the NSW Therapeutic Advisory Group Inc. August 2004

[BushyFromOz]

Most people will tell you they are "allergic" to something when they mean they get anything from a tummy upset to bit of a rash to anaphylaxis.

I generally write the degree of reaction eg "rash" or "nausea" etc next to the med name.

YEah, like mama guiseppie telling me a few weeks back she was allergic to oxygen, every time the hospital uses oxygen on her she gets the rash on the bridge of her nose...........

[mrsbull]

LMAO a rash on the bridge of her nose. Apparently it was not a short term "allergy".

Ok blonde moment does she mean her upper lip (from canula)?? No pun intended. (although it would have opened a few doors) ok it likely just did...