Moderator EMEDPA Posted February 5, 2019 Moderator Share Posted February 5, 2019 I can't remember the last time I ordered morphine. Peds: fentanyl(easy to titrate, minimal side effects) cardiac chest pain: fentanyl(studies show equivalent pain control to morphine with better side effect profile) ortho/procedures: fentanyl other pain where I want longer duration of action: dilaudid I just saw one of my partners treating an MI with morphine. Of course the guy started puking within minutes.... morphine is out of favor for CHF for a while now, so can't think of a good reason to ever use it...am I missing something? Link to comment Share on other sites More sharing options...
fishbum Posted February 5, 2019 Share Posted February 5, 2019 For dyspnea in the dying patient, I don't think anything has been studied as well as morphine. Other than that, I've got nothing. Link to comment Share on other sites More sharing options...
sks5966 Posted February 6, 2019 Share Posted February 6, 2019 Use morphine at my VA all the time for post op pain, prn. We supposedly have a dilaudid shortage. Bill Clark, PA-C Neurosurgery Link to comment Share on other sites More sharing options...
Eastcoast PA-C Posted February 6, 2019 Share Posted February 6, 2019 Our EDs are dilaudid-free, so I’ll use morphine if I need something that lasts. Fentanyl is my first line for pretty much everything though. Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
MediMike Posted February 7, 2019 Share Posted February 7, 2019 On 2/4/2019 at 8:12 PM, fishbum said: For dyspnea in the dying patient, I don't think anything has been studied as well as morphine. Other than that, I've got nothing. This. Except most of my dying patients have crappy kidneys so I punt to Vitamin D most often. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted February 8, 2019 Share Posted February 8, 2019 I'll confess to being a bit of old school, but I still use morphine both IV and IM as a "middle ground" for pain control, especially where I want something longer acting that fentanyl but not as strong as dilaudid. I've not seen dilaudid cause less nausea/vomiting than morphine. When both morphine and dilaudid were on shortage, I was using stadol with fair success. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 8, 2019 Author Moderator Share Posted February 8, 2019 stadol. talwin, and nubain are all great meds, which I have used at prior jobs. None of my current hospitals stocks them. IV tylenol is a nice alternative for the patient demanding "IV pain control"....:) Link to comment Share on other sites More sharing options...
sk732 Posted February 8, 2019 Share Posted February 8, 2019 I'd love to have IV Tylenol...but, meh, it ain't gong to happen in my system any time soon. I still use morphine, since I too am old and don't feel like doing the math regarding dosing...it's reasonably predictable, it's cheap (important where I work - hence no IV APAP or Ibuprofen) and has a decent hang time for those that need something with that. I do use fentanyl and hydromorph for certain things, sometimes ketamine. My go to for IV/IM initially is still usually Toradol (as long as they're not a moldy person, someone with a bleed or barely have a functioning kidney of course) or a Silver Bullet (diclofenac supp...used to be indomethacin but they're hard to come by now). Link to comment Share on other sites More sharing options...
kidpresentable Posted February 8, 2019 Share Posted February 8, 2019 I recently met an enterprising young lass who claimed she could use all our old morphine that’s just sitting around as a reagent in a highly marketable product popular with people of all ages. Can you believe it? We’ve met several times now, and she’s even offered me part ownership in her business in exchange for my help! Now I know all of you naysayers will ask: she definitely has a medical license, ok? She just keeps forgetting it at her house. I tell ya, I never had that kind of gumption when I was her age. She’s a real American... um... female version of the word ‘hero’... Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted February 9, 2019 Share Posted February 9, 2019 I agree, IV tylenol - Ofirmev, works really well. It's actually not that costly since it went generic, but I don't have it at my FT rural critical access job, nor do I have Talwin. I do have stadol fortunately. Link to comment Share on other sites More sharing options...
narcan Posted February 16, 2019 Share Posted February 16, 2019 The only argument I see for using morphine is that it comes in 4mg/1mL vials, so the nurses don't have to waste (i.e. as they would with hydromorphone or fentanyl unless you're just the candy man), which saves time and makes them like you more. From a purely physiologic/kinetics standpoint, I don't see any reason to use morphine over hydromorph or fentanyl depending on desired duration of effect and patient hemodynamics. I know that the anti-opioid folks argue that PO morphine has the least euphoria of the PO opioids and thus is "safer" in terms of prescribing, but I don't know if that translates to IV dosing, and I suspect it does not. And I second the use of morphine for palliation in the dying dyspneic patient. Just my 2 miligrams... (pun definitely intended) Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted February 16, 2019 Share Posted February 16, 2019 5 hours ago, narcan said: The only argument I see for using morphine is that it comes in 4mg/1mL vials, so the nurses don't have to waste (i.e. as they would with hydromorphone or fentanyl unless you're just the candy man), which saves time and makes them like you more. From a purely physiologic/kinetics standpoint, I don't see any reason to use morphine over hydromorph or fentanyl depending on desired duration of effect and patient hemodynamics. I know that the anti-opioid folks argue that PO morphine has the least euphoria of the PO opioids and thus is "safer" in terms of prescribing, but I don't know if that translates to IV dosing, and I suspect it does not. And I second the use of morphine for palliation in the dying dyspneic patient. Just my 2 miligrams... (pun definitely intended) Or can't do the simple math such as "How many mL's do I give of IBU/APAP to give a 200 mg. dose?" Link to comment Share on other sites More sharing options...
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