Poor outcomes when morphine used in AMI

[OzMedic]

I'm not sure why this is making news now. It was published in June of 2005. Below is a link to the abstract with a link to the full article. You will have to register to read the full article, but registration is free. CRUSADE is one of the largest databases on ACS in the world. Most of what we know and what we use to determine care comes from what is in this database. It is very similar to the trauama registry. It's a great source for data collection and analysis. Nothing shoddy about it. Morphine was shown to be associated with an increased risk in a subgroups, controlling for many factors. Sound EBM at work here.

http://www.ahjonline.com/article/PIIS00028...001493/abstract

Thanks for posting the info and for the feedback Doc. For some reason your link would not work for me but if you could please mention the article title and journal I will be able to find it from there as I have access to most online journals. Where do you think this research sits in relation to the way we use morphine in the treatment of pre-hospital ACS. Are we killing them with kindness? Or do you feel it is just the inappropriate prioritisation of morphine instead of aspirin, nitrates, thrombolytics and/or angioplasty in a more timely manner?

[sledogg1]

I wish we could use our versed on MI's and we are going research on fentanyl................still go with the nito times 3 then 2.0 mgs morphine up to 10 mg every 10 mins, I think they worry about RVH and hypotension which does happen and freaks you out but thats why a trendelburg postion and a simple IV in place for precautionary before you start meds is a good thing CYA.

We are starting glycoprotein 11b / 111a inhibitors for Non Q wave MI, Non-STEMI's and unstable angina so happy times

[ERDoc]

Thanks for posting the info and for the feedback Doc. For some reason your link would not work for me but if you could please mention the article title and journal I will be able to find it from there as I have access to most online journals. Where do you think this research sits in relation to the way we use morphine in the treatment of pre-hospital ACS. Are we killing them with kindness? Or do you feel it is just the inappropriate prioritisation of morphine instead of aspirin, nitrates, thrombolytics and/or angioplasty in a more timely manner?

The article was in the American Heart Journal. Here is another link to the abstract:

http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum

I think morphine should be lower on the list of meds to use. ASA, nitrates and betablockers should be priority in the field for ACS. I will give a small dose of morphine after the 3 SL ntgs if the pt still has pain, after that it is on to Tridil. Obviously the most important thing in a STEMI is the cath lab.

[sledogg1]

FORGOT THE ASA if no allergies............................................... :oops: