chinda11
Forum Junior
Topics: 19
Posts: 48
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7 days after sustaining partaila nd full thickness burns in ahouse fire an 8 year old boy is brought to the ED. He has acute asphyxia, Acute RDS , sepsis and multiorgan failure.He is bieng mechanicaly ventilated. After discussions with the parents a DNR order is written andthe patient6 is taken off of the ventilator. 20 minutes later his BP86/42 is Respiration is8/min Pulse 130/min. He periodcaly moans in pain.He is given iv morphine(20mg/hr). What would be the next best step in pain management.
A)decrease morphine untill his resp are more than 12
B)increase morphine
C)administer midazolam
D)adminiter naloxone
E)administer pancuronium
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| sera
Forum Senior
Topics: 14
Posts: 141
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B
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syra
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| klimt
Forum Guru
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Posts: 605
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B indeed
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| ram3
Forum Guru
Topics: 47
Posts: 510
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You are wrong increasing the morphine will most likely cause respiratory depression the answer is choice b Big Time
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| ram3
Forum Guru
Topics: 47
Posts: 510
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Choice a is the answer
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| hanwin
Forum Senior
Topics: 6
Posts: 157
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B. Make him pain free.
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| tanmaynator
Forum Senior
Topics: 12
Posts: 153
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hey guys they say that in such circumstances do whatever you can to reduce suffering of such patients.. but dont do anything to hasten the death of the patient.. and i heard someone in another forum say it is give midazolam as the answer.. he justified it saying he has worked with such patients and they give midazolam.. i dont think it is true or false and i am as confused on this one as most of us are.. but can anyone tell me if c may be an option here??
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| doc-o8
Forum Elite
Topics: 28
Posts: 370
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my first impression was c too. coz of the resp depression ass with morphine n midazolam will abolish the pain sensation obviously. coz decreasing the dose of morphine will not help with pain. cant increase it coz of resp depression so both can be excluded.
if anyone is sure fr the answer plz write.
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| dr in trouble
Forum Guru
Topics: 60
Posts: 592
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I guess midazolam.
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| ssrpk
Forum Fanatic
Topics: 154
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What should I avoid while using morphine?
Do not drink alcohol while you are using morphine. Dangerous side effects or death can occur when alcohol is combined with morphine. Do not take morphine with cold medicine, other narcotic pain medications, sedatives, tranquilizers, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result. Morphine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
http://www.drugs.com/MTM/morphine.html
suggests against midazolam
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| cirus
Forum Guru
Topics: 108
Posts: 740
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Well first giving midazolam in a pt on morphine will very much kill him even faster than giving morphine alone at a higher dose..
second midazolam is an ansthetic, so u have to intubate & ventilate the pt wich ur not supposed to do in this case..
Ans is increase morphine, this is the only thing u can do..
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| gr8doc
Forum Senior
Topics: 8
Posts: 210
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B.
Giving Midazolam will be labelled as Euthnesia & is not accepted in the US.
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