Morphine question.

[mjl1717]

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For a 80kg previously healthy service member. Who during theater was just shot in the mandible and shot on the right side of his chest.

What is considered a hefty dosage of morphine to give him. In order to relieve his pain and anxiety. Without going overboard?

 

[zelman]

We’re they on stage or in the audience?

 

[WVUPharm2007]

It really depends on their opioid tolerance level.

 

[PharmDBro2017]

It really depends on their opioid tolerance level.

True. 4mg of IV morphine is a reasonable place to start for GSW, then reassess pain level. I'm very conservative with opiates/pain meds, until someone has cancer or GSW.

 

[JustFillIt]

It really depends on their opioid tolerance level.

Yea - it’s essentially dosed based on tolerance. Start with low dose prn and go from there.

Pharmacy student?

 

[VA Hopeful Dr]

Acute pain at time or injury or chronic pain?

If the former, be generous. 4mg IV morphine if memory serves is about the same as 4mg hydrocodone. If I get shot, I would hope you wouldn't give me a norco 5 and then move along. I'd start with 8mg IV and reassess within about 15 minutes.

 

[mjl1717]

Acute pain at time or injury or chronic pain?

If the former, be generous. 4mg IV morphine if memory serves is about the same as 4mg hydrocodone. If I get shot, I would hope you wouldn't give me a norco 5 and then move along. I'd start with 8mg IV and reassess within about 15 minutes.

In general it is easy to joke about theater as a civilian. But in theater cooler heads prevail.
I should have stated acute pain. And yes morphine and hydrocodone both are equal to 1 MME

*During rotations I have heard that 10 mg of morphine is a hefty dose. I just had to confirm this.

Thank you guys for the quick responses!

 

[njac]

For a 80kg previously healthy service member. Who during theater was just shot in the mandible and shot on the right side of his chest.

What is considered a hefty dosage of morphine to give him. In order to relieve his pain and anxiety. Without going overboard?

We don’t use morphine in the trauma bay due to its potential to cause hypotension.

We usually start with fentanyl 50-100mcg pushes and transition to hydromorphone especially if the patient has an orthopedic injury.

But the test answer is 0.05-0.1 mg/kg of morphine or 0.5-1 mcg/kg of fentanyl.

 

[rxkrafted]

Acute pain at time or injury or chronic pain?

If the former, be generous. 4mg IV morphine if memory serves is about the same as 4mg hydrocodone. If I get shot, I would hope you wouldn't give me a norco 5 and then move along. I'd start with 8mg IV and reassess within about 15 minutes.

4mg **PO morphine is about equivalent to 4mg hydrocodone. If using IV morphine, its about 3x more potent as oral hydrocodone. Just an FYI.

 

[VA Hopeful Dr]

4mg **PO morphine is about equivalent to 4mg hydrocodone. If using IV morphine, its about 3x more potent as oral hydrocodone. Just an FYI.

Thanks for the correction (haven't had to deal with IV opioids in 8 years).

 

[mjl1717]

4mg **PO morphine is about equivalent to 4mg hydrocodone. If using IV morphine, its about 3x more potent as oral hydrocodone. Just an FYI.

Geez great info! And what about the potency of IM morphine?

 

[rxkrafted]

Geez great info! And what about the potency of IM morphine?

You would treat IM morphine the same as IV morphine when it comes to conversions because of the first-pass effect. The peak analgesia would be delayed in the IM morphine compared to IV route for obvious reasons.

 

[lane one]

During WWII they issued 1/4 grain and 1/2 grain syrettes for battlefield injuries. That's 16mg and 32mg respectively. Pretty hefty.

 

[NITRAS]

During WWII they issued 1/4 grain and 1/2 grain syrettes for battlefield injuries. That's 16mg and 32mg respectively. Pretty hefty.

There some MASH episodes where they are ordering morphine 1/4 and 1/3 grain.