I'm asking for your opinions on a call that I've been QAed on...

I had a 20 year old female pt who was 3 weeks pregnant. She was the front R unrestrained passenger of a vehicle that was T-boned on her side front 1/4 panel. There was no LOC or neck/back pain. Her only complaint was to her knee. She complained of pain, 10/10, and could not bear weight on the leg. Her knee was contused and swollen w/ no visible deformities. Other than her 3 week pregnancy, she had no medical history, she was on no meds (had not started pre-natals yet), and had NKA. She presented as A&OX4, BP - 130/90, HR - 114, RR - 18, SaO2 - 99%

Our pain management protocol states that anyone complaining of a pain level of 7 or above out of 10 shall receive pain management, contraindications notwithstanding, of course.

I administered 4mg slow IV push w/ NaCl maint. drip and had her on EKG monitoring throughout transport. Her pain level was 3/10 upon arrival at the ER.

Our medical protocol does NOT site pregnancy as a contraindication in morphine administration, only as a precaution.

When formulating your opinion, keep in mind that I informed the pt of the supposed risks involved and that she still chose administration. Also know that I have been QAed in the past for not administering morphine to patients who had previously complained of a pain level of 7 or higher.

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We use morphine all the time in pregnant pts. The risk of narcotics to the fetus is highest right around the time of delivery, almost solely due to post-delivery hypoventilation, and hardly worth considering at pretty much any other point (true for a few doses, anyhow, not use throughout the pregnancy, or worse yet abuse).

One thing to remember also with pregnancy is that pregnant females are volume expanded to the point of being anemic ("physiological anemia of pregnancy"), so a "normal" dose can also be a "low dose." Of course if pain went from 10 to 3, you can't argue with success.

Really? Everyone with a >7/10 pain gets pain management? Does that always necessitate narcotics or can that include a bag of ice and elevation of an extremity?

...and that's why I should read the post besides "pregnancy, opioids, dangerous?"

I had a sense of deja vú when I saw this topic...

On the other hand, it's good to have the discussion again about the relative safety of the opiods in everyone, pregnant or no. Even with heroin, which one would think was clearly dangerous to the fetus, there is conflicting evidence.

As summarized by Dr. Up-To-Date:

"It is difficult to establish the extent to which these problems are due to opiates versus coexistent maternal medical (eg, infection, vasculitis), nutritional, psychological, and socioeconomic (eg, prostitution, lack of prenatal care) difficulties."

In other words, people who shoot heroin aren't usually taking their pre-natal vitamins!

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