MORPHINE & the use of....

Discussion in 'Professionally Qualified, RAMC and QARANC' started by bigjarofwasps, Feb 21, 2007.

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  1. Hi Guys,

    I have a question that I`m hoping someone out there will be able to answer. It concerns Morphine- my attention has been drawn to the fact, that American service personal, don`t administer morphine for limb injuries. Why is this, has something changed since I did my training 10 years ago? I`ve also been informed that we no longer put IV`s into wounded casualties- I can see the reasoning behind this, but would very much like to know what the crack is with morphine. Can anyone help?

  2. Follow the drills as laid down in MATT 3 BDCT and you cant go wrong. Obviously dont stick the morphine in the limb with the injury/part missing.
  3. Morphine can affect how much you bleed (did know the ins and outs of it but having a mong moment and can't think straight so rather than get it wrong I wont try and go into details.)
    We know it's not the best thing to give, but if you tell someone he can't give his mate morphine when he's just had his leg blown off, he's not gonna like that. So on balance, we keep it.
    That's not telling you a lot, but hope it helps. If I find my notes on it, I'll PM and let you know.
  4. Cheers guys, I thought it was a bit crazy, when you`ve got some guy screaming blue murder, with his leg hanging off, and not give him morphine seemed crazy. If that was the case then what the hell can you give it for?
  5. BJOW

    dont forget that our american cousins run on different protocols to us.

    I dont see the logic behind not giving morphine to casualties ini obvious need of analgesia - come on someone, dig it out!
  6. The Americans do not tend to use opiate drugs, such as morphine, in the same way the Brits do - even in the US hospitals.

    The UK drills are fine. Morphine is one of the 'cleanest' and best pain relievers you can get. Yes, it does have side-effects but so do all drugs. Not all drugs can be made up in a pre-filled syringe, however, and so are not suitable for use in the field. I'm interested to hear about its effects on bleeding as that is not something I am aware of and is not in the usual literature.

    There are a hundred and one considerations that have been made by the experts and Morphine has come out the winner for the job we do.

  7. It is safer to transport a casualty in 1st degree shock - the old vid of the medics in vietnam proved that they were banging in IV fluid ++, the body could not build clots as the blood pressure was being artificially hieghtened by the use of the fluids.

    as the body commences 'self preservation mode' the BP is lower to aid clot formation at the wound. yes, cannulate the casualty as soon as (whilst they still have veins to target), but follow the protocols for fluid replacement as per BATLS

  8. :frustrated: I thought the use of IV`s in the field was old hat now as well?

    Its interesting the way the US & the UK train their soldires differently in the use of morphine, when our bodies are the same.
  9. Me too. Never heard that before, and I use morphine on a daily basis in people with bleeding injuries (usually surgically induced!).

    Giving morphine will, if anything, lower the BP. We usually aim for a systolic BP of about 100 in haemorrhagic trauma - less than this and organ perfusion falls, more and it increases bleeding from open vasculature.

    So I don't see why morphine should have an adverse effect on bleeding, and, before today, I've not heard that ever said in the 10 years I've been doctoring.


    One caveat - I've only been in green for a few months, but already I am realising military trauma surgery is not the same as civilian surgery. That's mostly to do with prioritisation, etc., but it does encourage me to stand corrected if someone knows different.
  10. I was working on the combat casualty care programme, it came up and I had a bit of a fit at my boss about it. It may have been related to DIC or reduced clot formation, I really can't remember. I just remember it was preferable not to give it. As I said, I can't remember exactly what it was, where it was from (or, therefore, how much I can divulge!!). It wasn't our research, so I'm probably ok mentioning it. However, when I'm next procrastinating having been given some sh!tty public health thing to do, I will get in touch with my boss and do a quick lit search.
    Will also go over the resus thing - I think BATLS protocol was 90SBP,or a palpable radial pulse, but long term there are problems with organ failure due to the lack of perfusion, there is research underway to get round this (again, will check how much is in the public domain, when I know, I'll tell you what I can!).
    Sorry my posts aren't really telling you anything useful, on a paeds and O&G rotation, so all the trauma stuff I've learnt has been forgotton for now!
  11. the bodies are the same, but the lawyers are different
  12. Morphine is a potent vaso-dilator, meaning that it will lower the blood pressure. However, as someone above mentioned, we aim for a systolic BP of 90-100 during haemorrhagic trauma. So, if the patient is in pain with a SBP (systolic blood pressure) of >90, give morphine. If the SBP is <90, give fluid (NaCl or Hartmanns) until a radial pulse is present (=SBP >90) and then give morphine. Titrate the morphine to effect, and titrate the fluid to SBP of 90-100.

    And remember, all bleeding stops. (eventually)
  13. Like Badpan states.

    Irrelevant if you do fluid replacement therapy the patient needs immediate canulation and NACL attached to keep the canula open. A slow rate of ifusion will do absolutely no harm and is also needed once further medication needs to be given IV.

    It is a bugger to canulate a person in shock and an IV in the jugularis is a crappy thing to do (but not a hard procedure).
  14. Ventress

    Ventress LE Moderator

    Medical work- fascinating.
  15. Perhaps a bit bone of me, but at the stage people would be getting morphine into their mates, haemostasis would be (at least attempted) acheived by direct/indirect pressure?

    I know that that is not pertinant to noncompressible bleeds however.