Hi all, just curious to see what you thought of this -
65 yo male admitted to ER for acute back pain following a slip or strain (I forget which). I give 10 mg Morphine and (I want to say 30 mg but can't remember) of Gravol IM to ventrogluteal. Pt has not had Morphine before that he remembers.
So 15 minutes later the wife hits the callbell and I return to find the pt diaphoretic++, breathing quickly and deeply, appearing anxious. He was warm and clammy all over, even his wrists were wet. Wife reports that his eyes were rolling back in his head. V/S were WNL but BP was about 20 points lower when it was taken 1hr previous. Pt reported pain 0/10.
I wasn't sure what to say as I haven't seen a reaction like this one. I asked another nurse and she said morphine could do that sometimes. I am curious about the mechanism of action in relation to this. Can anyone shed some light on why this might happen?
Jun 11, '11
by leslie :-D
Quote from canundergrad
So 15 minutes later
the wife hits the callbell and I return to find the pt diaphoretic++, breathing quickly and deeply, appearing anxious. He was warm and clammy all over, even his wrists were wet. Wife reports that his eyes were rolling back in his head. V/S were WNL but BP was about 20 points lower when it was taken 1hr previous. Pt reported pain 0/10.
good point about pointing out the timing, DIVA RN.
gravol was given im...so any reaction wouldn't have presented itself before then.
morphine given iv...highly doubt reaction would be 15 mins later.
i've given morphine my entire nsg life, in all routes, and have never seen or heard of a reaction like this.
my instincts and knowledge, still point to the gravol.
Last edit by leslie :-D on Jun 11, '11
: Reason: addressed wrong poster.
No, I don't believe Gravol is used anywhere in the USA. It's related more to Dramamine than Benedryl, though. Google it
The "rush" part you describe could be the morphine, of course! I didn't know that was part of the equasion. 10mg may have been a "little" hefty for a opiate naive person, and if it was given IV push, it could have felt like the top of his head was coming off.
By the way, this would not be considered a true allergic reaction
...such as anaphylaxis but a reaction to a narcotic being given as an IV push...it could have and probably would have happened with demerol or dilaudid as well. I hate to think that the guy is labled as "allergic" to morphine because of this reaction or side effect. It is not like he went into anaphylaxis or stopped breathing and you had to reverse the effects with Narcan or call a code or something.
The eyes rolling back, still sound like the gravol as does the increased RR and the anxiety. That stuff can cause some paradoxical symptoms. It just didn't sound like good old morphine
Last edit by diva rn on Jun 11, '11