Nubain

[Nate]

Background...

Responded to a call of a 44 year old female who was involved in an auto-ped that was a hit and run. AOSTF said patient laying supine c/o left sided pain and bilateral leg pain. Patient was found to have road rash all over, fx humerus, and open Fax of the radius/ulna all on the left side. Patients husband reports patient has had 12 beers (she says it was probably more), and no one really knows how she got out there. Patient states she walked out of beer and then woke up where she is now. Patient also states she doesn't remember what I was talking about when I asked her to remember a simple word. She had an abdomen that was soft, distended about a good 6 inches. Patient takes no medications, is allergic to no known drugs/foods, and has a past medical history of a hysterectomy one year ago. Witnesses state patient walked out of bar, crossed two lanes of traffic and a turning lane and was struck by a car.

I could only get an 18g in her RAC, she was stable (for now) and the bleeding was controled. Her pain was still a 10, but she admits that it was lower after we splinted the fx bones. I did not give any nubain because things just weren't "adding up." When I got to the hospital, one of the residents ordered 4mg of Morphine, then told me I was ignorant for not giving anything for pain. Well one of the staff doctors walked in, saw the order, and then jumped all over his butt for giving morphine to someone who had 12 + beers and her blood alki level was unkown.

Question...

How many services address the use of pain medications patients with suspected ETOH use? One of the contraindications for Nubain is ETOH. Would you have given her the Nubain or left that for the ER to handle? Keep in mind that we have no other findings with the abdomen other then it is distended.

[N.S. ACP]

Background...

Patient also states she doesn't remember what I was talking about when I asked her to remember a simple word.

Question...

How many services address the use of pain medications patients with suspected ETOH use? One of the contraindications for Nubain is ETOH. Would you have given her the Nubain or left that for the ER to handle? Keep in mind that we have no other findings with the abdomen other then it is distended.

Not being familiar with Nubain, I looked it up and it appears to have similar properties to morphine, With the statement above I would probably hold off on the pain meds, according to my protocols. 12 beer in a person would be alot and Yes I would let the ER deal with pain management in this one.

[vs-eh?]

A drunk, altered (could be from ETOH, head injury, who knows), and likely polytrauma (assuming the distended abdo = you querying injury) means no pain meds.

I would be surprised if anyone would/is allowed to give analgesia is this situation. Synergistic effects with the ETOH = more problems then they are worth unless you are planning to intubate the patient.

[Nate]

Nubain (nalbuphine) is a synthetic version of morphine. It has similar interactions and side effects, however it is a huge no-no in suspected head injuries. Not that many services carry it, we do because it is cheaper then morphine and we don't use that many narcotics.

[tinman694]

At least you carry something...

Only thing we can carry and use is valium--of course not on a trauma.

We do have the Texaco Drip though...

[Nate]

At least you carry something...

Only thing we can carry and use is valium--of course not on a trauma.

We do have the Texaco Drip though...

Texaco, I thought they only made motor oil and gas? :shock:

At Bay Star we have Valium, Versed, and Toradol. At City of South Houston we have Valium and Nubian as our only controlled substances. It would be nice to gain morphine at both services for the cardiac (chest paint/CHF) aspect as well as pain.

Now I have another question, since Nubian is a synthetic morphine, what is keeping it from being used in cardiac chest pain or CHF?

[retired_medic61]

Texaco, I thought they only made motor oil and gas? :shock:

At Bay Star we have Valium, Versed, and Toradol. At City of South Houston we have Valium and Nubian as our only controlled substances. It would be nice to gain morphine at both services for the cardiac (chest paint/CHF) aspect as well as pain.

Now I have another question, since Nubian is a synthetic morphine, what is keeping it from being used in cardiac chest pain or CHF?

Nubain is a mixed narcotic agonist-antagonist with minimal hemodynamic effects, that is Nubain will activate some opiate receptors while blocking others. Morphine causes dilation of the venous system which decreases cardiac preload whereas Nubain does not have this effect.

[Nate]

Nubain is a mixed narcotic agonist-antagonist with minimal hemodynamic effects, that is Nubain will activate some opiate receptors while blocking others. Morphine causes dilation of the venous system which decreases cardiac preload whereas Nubain does not have this effect.

So was this knowingly eliminated when they designed this drug, or was it that it just so happened to turn out that way?

[Ridryder 911]

It all depends on the LOC of the patient, if I will consider administering analgesics. Although Nubain is a synthetic opioid type of analgesic, I have not seen it as effective as Morphine for certain type of pains. We use it like candy for headaches....

Most of the time if I will not administer analgesics, if there has been any questionable alcohol abuse.

R/R 911

[AZCEP]

I think it will be tough to find anyone who will give a significant dose of a narcotic to someone with this degree of "pain" medicine already on board.

If the patient was communicating with you, and tolerating the pain, my tendency would be to hold off as well. If the pain was unbearable, then I may consider using a little. This might be a good time to get medical control involved though. Explain the situation, and let them decide.