morphine IV

when you say infusion are you talking morphine drips or pca's? i'm assuming you mean iv push. you're supposed to give it slow iv push, which means over 1-2 minutes. there isn't a specific dose that is considered an overdose. an overdose is any dose that causes severe resp depression and altered level of consciousness. you want to watch for resp depression, some people get bad hallucinations, people can get dizzy and nauseous. it can cause constipation. people can get clammy from it and it may burn while being pushed. i like to dilute mine with saline to help prevent that. it can also cause pretty bad headaches for people. don't give if combined with alcohol. it can make any and all side effects worse......hope that helps.

You can dilute it with saline and push it slowly - VERY slowly on an elderly patient.

Make sure you have them hooked up to a sat and pulse monitor and have 02 ready (cannula and non-breather mask) because esp in old people, narcotics make them stop breathing so well :-(

You're usually safe with 1ml/minute for most meds, just remember Morphine you can get a local histamine reaction causing redness and itching--does not necessarily mean they are allergic...

I have given IVP of Morphine as small as 0.5mg and as big as 90mg...it really depends on the size of the patient and tolerance...

thanks to the people that replied...you've all been very helpful..the doctors in our ER like to give morphine to patients in severe pain (usu renal colic pts), and they usually order 10mg IV, that's it. since I'm new in the unit, the "older" nurses just say just give 4mg slowly then after a while 2-2-2mg.

i was also wondering if a doctor ordered 30mg of morphine for a patient, would this be an overdose or still acceptable, because some say this is an overdose. i've been looking through literature about morphine and haven't encountered a certain dose considered to be an overdose.

what causes the headache in these patients given morphine?

morphine as an IV push - dilute to 1 mg / ml with a diluent approved by the supplier / your pharmacy and give slowly and titatre to effect ....

how big your inital bolus will depend on a number of factors as others have said

herein rightpondia it's usually up to 10 mg as the initial dose ( as our ampoules are 1 ml of 10 mg/ml ) and my initial bolus will be 2 to 5 mg based on the factors discused above - after than it;s .5 to 1 mg at a time to titrate ...

i've seen 10 mg whacked straight in to 'normal' sized people in lots of pain ... and it;s 'barely touched the sides' of the pain, i've seen people out of it after 2 mg given very slowly ... people are individuals ...

Certain patient populations like Sickel cell patients can tale LOTS of MS.

There is no specific does of any narcotic that is an overdose. It's all relative. I've had to bad patients who were given 2mg of MS till the narcn was ready. And I"ve seen kidney stone patients take 8mg of Dilaudid and keep asking when the pain was going to go away.

That is why we're nurses and not technicians. Being able to make judgment calls and the ability to deal with the consequences of when we make the wrong call. The nice thing with opiods, is Nalaxone works pretty well. :)

The other thing to remember when dosing, is that if your dosing before a procedure like a closed reduction, the pt's response will be different after the pain stimulus is removed. The screaming shouilder dislocation can suddenly be apnic once the shoulder is reduced.

Oh and don't forget to be specif when getting the patients history. They might not tell you that they have an extra fentanyl patch on.

The headache comes because Morphine produces vasodilation. This is why we give Morphine for chest pain patients. The vasodilation is great to reduce constriction due to angina, but it causes headaches due to the vasodilation. These are usually transitory in my experience.

Just remember 1 mg of Dilaudid equals 10 mg of Morphine. IF it is a pt who does not normally receive pain meds, I would push this very slow or hang it in a 50 ml bag.

The other thing to remember when dosing, is that if your dosing before a procedure like a closed reduction, the pt's response will be different after the pain stimulus is removed. The screaming shouilder dislocation can suddenly be apnic once the shoulder is reduced.

Interesting point. Good call, Craig.

Also remember, many providers tend to under-dose patients with morphine. I see people give little 2 mg squirts to major trauma patients. It would seem this is more therapeutic for the provider. (Gives us a warm fuzzy that we are doing something for the pain.) If a patient is hemodynamically stable and no specific contraindications exist, 0.1 mg/kg slow IV is an appropriate dose for many patients. I understand if you have reservations about giving 7-10 mg of morphine a pop; however, we are more than happy to push 100 mcg of fentanyl. Somehow, the logic breaks down when you really think things through.

Just remember 1 mg of Dilaudid equals 10 mg of Morphine. IF it is a pt who does not normally receive pain meds, I would push this very slow or hang it in a 50 ml bag.

Stupid question as I know these are both narcotics but I am in psych now and it's been a while since I give a lot in the way of these meds.......but are they chemically the same just one more potent? Curious as when I was....on the other side of the sheets, so to say, in for a GI bleed myself they gave me Morphine multiple times and it helped and I felt..."normal". Then, without telling me they came in and hung a pain med as I requested but suddenly after it started I felt so drunk! Goofy! I immediately was calling the nurse to find out what was hung and they had decided to switch from Morphine to Dilaudid. I hated the dilaudid and requested to have it stopped and switched back to the Morphine. Only problem was when I got up to the floor they would not give me the same higher doses as I got in the ER so I was in pain. Then when I asked for more for pain they were like, you are already getting 2mg every 4 hours! Yeah big whip I was getting 4mg every 2 hours in the ER!! LOL So I sat and suffered......got I hated being a patient! I'm a much better nurse!!! LOL

They are chemically different but Dilaudid is codeine based like morphine so they have some similarities. I always "pretreat" people getting higher doses of MS or anyone getting dilaudid with a one time dose of Zofran because these two can cause n/v very quickly even when pushed slow depending on the pt.