I have a general question regarding how you dose your patients with narcotics.
Frequently we'll get patients in acute severe pain (kidney stones, dislocations, low speed MVCs) in our Level V ED, and the docs often order analgesics like this:
Morphine 2.5-5 mg IV PRN
My question is - how would you administer this to effectively control pain safely? I come from an oncology frame of mind where, if the patient is still breathing and has an adequate GCS, RR, and BP, they can be safely dosed. If the patient is in severe pain, I will normally give the max dose and give the lesser dose on follow up Q15 min (if they are coming under decent pain control - otherwise I'll repeat the high end).
Other nurses tend to be a lot more cautious and will often see how they do on the lower end (2.5) and give the PRN less frequently (heard the other day: "Well, it's only been 35 min..")
I know that the research suggests that patients' pain is typically undermanaged in the ED.
When you have someone come in under these criteria, how do you approach pain control? Ultimately I want to give my patients as much pain control as is safe, but I'm not sure if my approach is the most effective.
Thanks for your thoughts, and bestowing your knowledge upon me
Pain Treatment Guidelines - Descriptions
This may provide some help but that is NOT a complete order. It legally needs to have a frequency otherwise you are practicing medicine. Once you have a frequency on the order it will be much easier for you to select a dose within the range b/c you will know when you can administer another dose if needed. Yes I am aware that many pain protocols will state to start within the low range but of key importance is to determine if the pt is opioid naive or not. I can tell you from personal experience that if you have been on narcotics when you experience acute pain it takes a definite increase to get pain relief. I had to wait 8 mos for surgery one time and was taking a po narcotics to manage the pain..I was shocked when the MS did not enough touch the post op pain I had! Interested to see the other opinions as well!
Last edit by iluvivt on Nov 4, '12