Morphine anyone? That’s the 64 thousand dollar question.
I don’t usually do this, but I’m going to post a very personal observation. During the last few years, CID Review has posted a number of articles about the use and abuse of narcotic medications. In fact, CID Review recently posted about some prescription guidelines that have been implemented in Ohio.
But, this post is personal…
The other day, my wife was in a fender-bender on the freeway. She’s fine and the car is fine. She was actually in stop-and-go traffic, LA style. The car in front of her stopped and my wife stopped. Unfortunately, the lad behind my wife did not stop. He bumped her from behind and her car was forced forward, hitting the car in front. So, she had a duel collision; a twofer, if you will.
After the accident, she seemed to be shaken but all right. She checked her car, found it to be okay and pulled it to the side of the freeway.
She then got out of the car and was visibly shaken. The gentleman who hit her called 911 and paramedics responded.
Since my wife was a bit dizzy and said she had some shortness of breath and chest tightness, the paramedics elected to take her to the nearest emergency room (ER). Good call on their part. Better to be safe than sorry.
By the time I got to the ER my wife had settled down. However, since she stated she had some chest tightness, she was scheduled for a stress EKG on the following morning. Again, good call. As an aside, it was normal.
At any rate, while I was there, the ER nurse came in the room to check on my wife. The nurse asked her how she was feeling. My wife stated that she was feeling much better but her neck was a bit sore. Understandable.
The nurse asked my wife to put a number on the neck pain. She said to rate if from 0 to 10, with 10 being the worst. That’s a pretty common thing to do.
My wife indicated that her neck pain was about a 4. Not being able to “feel her pain” and not knowing how much pain she was really in, having the patient rate the pain makes a lot of sense. Puts a perspective on things. With that in mind, a 4 on anybody’s scale is considered tolerable.
The ER nurse later asked my wife if she would like some morphine for her neck pain. Nothing against the ER nurse, but I have a few problems with that question.
First, a 4 on a 10 scale does not warrant narcotic medication. Period!!! A 4 is a tolerable pain. And, tolerable pain does not warrant morphine. Period!!!
Second, when you have a patient who potentially (I said potentially) has a heart problem (remember the chest tightness?), giving a sedative like morphine doesn’t seem to make sense. At least not to me.
Third, it doesn’t seem to me that a clinician should ask a patient if they want morphine. If they really need it, fine. But asking the patient if they want it seems a bit curious, if not wrong.
So here’s the take-home message… with all of the concerns about the use and abuse of narcotic medications (opioids), it seems the medical establishment is far too casual with their readiness to use them. Some better training in the problems with morphine and morphine derivatives seems to be in order.
I have nothing against the ER staff. They did their job superbly. But, I do have a problem with the apparent casual regard for something as powerful, and potentially problematic, as morphine.
Just my thoughts…