Morphine for STEMI with NO chest pains

Snapshot on who is giving morphine for patients with a STEMI who has no chest pains?

cheers

Mike

Replies to This Discussion

Permalink Reply by Jason Bowman on July 9, 2011 at 11:04am

Mike, I don't know how familiar you are with searching research but these have helped me tremendously. For straight research I love google scholar http://scholar.google.com/ and for researching EMS protocols check out dalhousie university's evidence based protocol project at http://emergency.medicine.dal.ca/ehsprotocols/protocols/toc.cfmI don't agree with of it but it's a good starting place. Best of luck to you!

Mike Bjarköy said:

Thanks for the insight all, I thought I was missing something here but obviously not.

One of the contracts I have is with an NHS ambulance service in the UK which have stated recently...

Morphine

Appropriate analgesia is vital, as pain activates the sympathetic nervous system, increasing the

cardiac workload and therefore myocardial oxygen demand. JRCALC 2006 therefore includes ‘pain

associated with suspected myocardial infarction’ as an indication for the administration of

morphine. A clear rationale must be documented in the procedural exclusions section of the PCR

for any suspected or confirmed MI where morphine is not administered.

Given the benefits of morphine in reducing cardiac pre-load and the overall workload of the heart,

the Trust also fully supports the administration of 2.5mg morphine in cases of suspected or

confirmed myocardial infarction where pain is not experienced (eg silent MI). Administration in the

absence of pain, should continue to follow the JRCALC contra-indications and cautions for

morphine.

So I may do a bit of digging around in the journals before replying to this recent release by my service - for armed is a good position to be in. I couldn't possibly comment on the knowledge base of those who have released this but am confident the above is not the best treatment option - as you have rightly pointed out.

cheers

Mike

▶ Reply

Permalink Reply by Mike Bjarköy on July 9, 2011 at 1:01pm

Hey Jason,

I will certainly look at the link you gave me. I am ok with research. I'm was an associate researcher at the Medical Care Research Unit at Sheffield University and have done research for the UK Department of health. Also have an MSc and a PgDip.

But I always welcome fresh ideas and advise as I don't profess to know everything and that is why I ask guys like you rather than just assuming I know the answer because there's always areas I have not considered before.

many thanks

Mike

Jason Bowman said:

Mike, I don't know how familiar you are with searching research but these have helped me tremendously. For straight research I love google scholar http://scholar.google.com/ and for researching EMS protocols check out dalhousie university's evidence based protocol project at http://emergency.medicine.dal.ca/ehsprotocols/protocols/toc.cfmI don't agree with of it but it's a good starting place. Best of luck to you!

Mike Bjarköy said:
Thanks for the insight all, I thought I was missing something here but obviously not.

One of the contracts I have is with an NHS ambulance service in the UK which have stated recently...

Morphine

Appropriate analgesia is vital, as pain activates the sympathetic nervous system, increasing the

cardiac workload and therefore myocardial oxygen demand. JRCALC 2006 therefore includes ‘pain

associated with suspected myocardial infarction’ as an indication for the administration of

morphine. A clear rationale must be documented in the procedural exclusions section of the PCR

for any suspected or confirmed MI where morphine is not administered.

Given the benefits of morphine in reducing cardiac pre-load and the overall workload of the heart,

the Trust also fully supports the administration of 2.5mg morphine in cases of suspected or

confirmed myocardial infarction where pain is not experienced (eg silent MI). Administration in the

absence of pain, should continue to follow the JRCALC contra-indications and cautions for

morphine.

So I may do a bit of digging around in the journals before replying to this recent release by my service - for armed is a good position to be in. I couldn't possibly comment on the knowledge base of those who have released this but am confident the above is not the best treatment option - as you have rightly pointed out.

cheers

Mike

▶ Reply

Permalink Reply by James Fox on March 14, 2012 at 3:43pm

Our Regional EMS protocols dont actually have a specific "STEMI" protocol or algorithym. We treat per chest pain, and if your chest pain is greater than a 5 on the pain scale and isnt resolved within 3 NTG's then you get 2mg morphine up to 10mg without phsycian orders. Our region does not carry fentanyl otherwise that would be the perferred medication. Also, we treat our patient, not our monitor. The only other reason we give morphine for cardiac is if there are bilateral crackles (rales) present, and we only give morphine after NTG, Lasix and CPAP.

▶ Reply

Permalink Reply by Mike Bjarköy on March 17, 2012 at 1:55pm

Thank you James,

Good to know your protocol, put things into perspective.

The morphine for no chest pain cardiac events is a hot debate here among senior clinicians nationally.

People I trust are saying to give it with a pain score of 4 or more which I think is a bit on the high side but we follow guidelines anyway so as a UK paramedic we could follow either advise or do as we believe to be correct for the patient.

I will let you know the outcome when I hear.

▶ Reply

Permalink Reply by Justin P on April 28, 2013 at 1:49am

It wouldn't be my first choice, because its primary mechanism of action (analgesia) is not needed; however your STEMI patient is likely to have a great deal of anxiety so I would consider some versed or ativan instead which will reduce anxiety and preload (both beneficial to the STEMI patient). Also if available metoprolol should be given as it is a class I drug for acute STEMI's that has been shown to reduce morbidity and mortality from acute MI.

Justin Poland, A.A.S., LP, NREMT-P