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"The medikit was actually really comprehensive ... that contained ... even morphine." I am surprised that it contained morphine. Pain killers would not help mu

"The medikit was actually really comprehensive ... that contained ... even morphine." I am surprised that it contained morphine. Pain killers would not help much in resolving whatever medical issue is occurring. Besides, is it not dangerous to report the fact that morphine is available on a flight? Some medkits are easily accessible and can be taken when the flight attendants are not looking.

moioci 14y ago
When you have a myocardial infarction or acute pulmonary edema inflight, you'll be glad there's morphine available.
- supwiggles 14y ago
  It is amazing how well morphine can work, and how utterly useless it can be at other times. I found it to be incredibly helpful during the AMI cases, especially for putting the patient as ease, especially when they understand the gravity of the STEMI that they are currently experiencing. We went to a fractured tib/fib (Football injury) and we loaded him up with the maximum dose over the course of treatment (50 minutes or so) and it didn't even touch the sides. Looking back we probably should have called for the IC guys and done some ketamine + realignment.
FireBeyond 14y ago
As an opioid in rapid sequence induction, potentially used for tracheal intubation.
- JshWright 14y ago
  Opioids are rarely in RSI. RSI uses a sedative and a paralytic. The sedative is almost always a benzodiazapine, and occasionally a dissociative or hypnotic sedative like ketamine or etomidate. Morphine would be a _very_ poor choice for a sedative in an RSI protocol.
  - FireBeyond 14y ago
    Actually, no idea why I grabbed onto morphine in that discussion. Our protocols call for vecuronium, atropine, etomidate, succinylcholine. However, we do also use fentanyl if indicated to deal with tachycardia and ICP. One other thing I noted in the original article was bemoaning the lack of pulse oximetry, "to assess if patient was exchanging oxygen". Treat the patient, not the number. If your patient is in respiratory distress but has 100% SpO2, treat the distress. If your patient appears /comfortable/ and /normal/ at 90%, go with what seems appropriate to their case. (In fact, our MPD excludes Pulse Oximetry and Blood Glucose from BLS protocols on the grounds of 'treat the patient' - though my opinion tends to differ on the latter).
    - cwb71 14y ago
      Reading between the lines just a little bit, I got the feeling based on the doc's description of his patient's behavior earlier in the flight that he suspected she was just being a drama queen and that this was more of a "psychiatric issue." Perhaps he wanted to test that hypothesis?
    - jeltz 14y ago
      If I was the patient I would love to hear that my oxygen levels were normal and that I am not at any risk of dying any time soon. I would say treating the patient should include first measuring how urgent it is. Additionally if you panic you can easily imagine having trouble breathing, or that your trouble breathing is worse than it actually is. I have experienced this first hand when just relaxing removed most of my problems.
      - FireBeyond 14y ago
        There's a very interesting book I read called "The Worst Is Over", which discusses this very thing, and talk in detail about how to talk calmly, soothingly and reassuringly to your patient, and the benefits thereof, from the more obvious (anxiety) to the less (pain relief and the perception thereof).
    - JshWright 14y ago
nnethercote 14y ago
If major turbulence occurs -- enough that passengers are thrown around -- I can see all kinds of uses for morphine.

moioci 14y ago

When you have a myocardial infarction or acute pulmonary edema inflight, you'll be glad there's morphine available.

supwiggles 14y ago
It is amazing how well morphine can work, and how utterly useless it can be at other times. I found it to be incredibly helpful during the AMI cases, especially for putting the patient as ease, especially when they understand the gravity of the STEMI that they are currently experiencing. We went to a fractured tib/fib (Football injury) and we loaded him up with the maximum dose over the course of treatment (50 minutes or so) and it didn't even touch the sides. Looking back we probably should have called for the IC guys and done some ketamine + realignment.

FireBeyond 14y ago

As an opioid in rapid sequence induction, potentially used for tracheal intubation.

JshWright 14y ago
Opioids are rarely in RSI. RSI uses a sedative and a paralytic. The sedative is almost always a benzodiazapine, and occasionally a dissociative or hypnotic sedative like ketamine or etomidate. Morphine would be a _very_ poor choice for a sedative in an RSI protocol.
- FireBeyond 14y ago
  Actually, no idea why I grabbed onto morphine in that discussion. Our protocols call for vecuronium, atropine, etomidate, succinylcholine. However, we do also use fentanyl if indicated to deal with tachycardia and ICP. One other thing I noted in the original article was bemoaning the lack of pulse oximetry, "to assess if patient was exchanging oxygen". Treat the patient, not the number. If your patient is in respiratory distress but has 100% SpO2, treat the distress. If your patient appears /comfortable/ and /normal/ at 90%, go with what seems appropriate to their case. (In fact, our MPD excludes Pulse Oximetry and Blood Glucose from BLS protocols on the grounds of 'treat the patient' - though my opinion tends to differ on the latter).
  - cwb71 14y ago
    Reading between the lines just a little bit, I got the feeling based on the doc's description of his patient's behavior earlier in the flight that he suspected she was just being a drama queen and that this was more of a "psychiatric issue." Perhaps he wanted to test that hypothesis?
  - jeltz 14y ago
    If I was the patient I would love to hear that my oxygen levels were normal and that I am not at any risk of dying any time soon. I would say treating the patient should include first measuring how urgent it is. Additionally if you panic you can easily imagine having trouble breathing, or that your trouble breathing is worse than it actually is. I have experienced this first hand when just relaxing removed most of my problems.
    - FireBeyond 14y ago
      There's a very interesting book I read called "The Worst Is Over", which discusses this very thing, and talk in detail about how to talk calmly, soothingly and reassuringly to your patient, and the benefits thereof, from the more obvious (anxiety) to the less (pain relief and the perception thereof).
  - JshWright 14y ago

nnethercote 14y ago

If major turbulence occurs -- enough that passengers are thrown around -- I can see all kinds of uses for morphine.