Our new regional guidelines are now on-line at:
North Central Regional EMS Guidelines
I've been using the new morphine pain dosing with great success.
0.1 mg/kg slowly over at least 4-5 minutes up to a total of 10 mg.
If after 10 minutes, patient still reports moderate to severe pain, another 0.05 mg/kg slowly over at least 4-5 minutes up to a maximum total dose of 0.15 mg/kg
I've done a couple of hip fractures and one severe ankle fracture -- all recieved a good measure of relief.
***
Speaking of pain relief there is a fascinating article in the New York Times Sunday magazine about a doctor who is in jail for "over" prescribing pain meds. It raises some interesting issues between a doctor's right to practice and to heal versus society's fear of drug addiction.
When is a Pain Doctor a Drug Pusher?
An excerpt:
Proper pain management will always take time, but the D.E.A. can at least ensure that honest doctors need not fear prison. It should use the standard it claims to follow: for a criminal prosecution to occur, a doctor must have broken the link between the opioid and the medical condition. If the evidence is of recklessness alone, then it should be a case for a state medical board, the D.E.A.’s registration examiners or a civil malpractice jury.
Undoubtedly, such a limit will allow a small group of pill-mill doctors to escape prison. But America lives with freeing suspects whose possible crimes are discovered through warrantless searches or torture — and unlike other suspects, doctors who lose their licenses are as incapacitated as those behind bars. For cases without the broken connection, prosecution is too blunt an instrument. It runs too high a risk of condemning innocent physicians to prison and discourages the practice of a medical specialty desperately needed by millions of Americans.
Pain patients are the collateral victims here...
Opioids have immense power — both to harm and to heal. They can be life-destroying, but high doses allowed Ben to work, to be with his family, to be who he is. In its prosecutions of pain doctors, the government fails to recognize the duality of these drugs. Ben’s wife told me: “When Ben first went to Dr. McIver and filled out the form on what he used to be able to do and what he could do now, he cried. McIver said to him, ‘I’m going to get you back to doing what you used to do.’ And he did.”
I found the following progressive policy statement on the Connecticut Medical Examining Board (the disciplinary body for MDs in out state) web site:
Use of Controlled Substances for the Treatment of Pain
It includes the following passage:
"the board may not judge the validity of treatment solely on the quantity and duration of medical administration...may take into account the outcome of pain treatment including patient functioning/and or quality of life; and will not assume that all types of pain can be completely relieved."
