fongch
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This question has previously been discussed without convincing conclusion. Therefore I am bringing it back to table.
Seven days after sustaining partial and full thickness burns in a house fire, a 7 y/o boy has brain asphyxia, ARDS, multi organ system failure and sepsis. He is being mechanically ventilated. After consultation with his parents, a do not resuscitate order is written. And the boy is removed from the ventilator 20 mins later. BP 86/42, pulse: 130, RR 8 min. he periodically moans in pain. His current pain medication is morphine iv (20mg/hr). Which of the following is the most appropriate next step in management?
a) Decrease in morphine until the patient’s respirations are greater than 12
b) Increase in morphine
c) Administer midazolan
d) Administer naloxone
e) Administer pancuronium
The answer is likely either A or B. Let's vote.
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| NE
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I guees it is B- he has the right to die in dignity not in pain!
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| radonc
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It is clearly B. Pain control in the setting of palliative care.
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| intoxication
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finally guys let me know da answer.....(B)...why it shudnt be (A)..dono thts y asking....
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| fox
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This is straight fwd....ans B. Pls refer first aid ethics
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| Justice
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b) Increase in morphine
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| usmle12
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YEAH its B cz 1> he is has to die absolutely so why in pain
2>pain relief has to be given priorty even though it is shortening survival
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| doc_clotaire
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I do not agree with B ( Do Not Rescuscitate does not mean volontary kill the patient.
First of all , they are giving him too much Morphine (20mg/hr). which basically depress his respiratory rate , if you increase the dose , you gonna kill him for volontarily . DNR doesn ' t mean let him die with no pain , DNR mean : you jus cannot do any heroic action to bring patient 's life back( ie intubation , CPR ect....)
I am going with
a) Decrease in morphine until the patient’s respirations are greater than 12
and then may be later you can give him some respiratory center booster before you give increasing the dose because giving him more morphine knowing that you will kill the patient even it 's DNR
IT IS JUST NOT RIGHT DOCS 
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| ram3
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The answer is Big Time if you increase the morphine it might cause the patient to die
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| eckimazuro
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I quote First Aid: "It is ethical to provide palliative treatment to relieve pain and suffering EVEN IF SUCH TREATMENT MAY HASTEN A PATIENT´S DEATH."
I´ll go with B, give the poor kid some morphine.
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| drxyz
Forum Senior
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i got the same type of qtn in my step 1 real exam(elderly male with terminal cancer in severe pain),i choose b.
after listening to ethics dvd lectures,i realised that was wrong answer.
according to the ethics dvd lectures answer is (a)
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| cirus
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B
do what u can to make him comfortable, even if u think that morphine will kill him
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| elitoki
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B
we have to make patient confortable with pain.
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| kpmle2
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b) Increase in morphine
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| neuroblastoma
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High-dose morphine was defined as the need for 300 mg or more of morphine per day. This group was divided further into patients receiving 300 to 599 mg per day and those receiving more than 599 mg per day.These high doses of morphine can be used without concern for significant side effects, including respiratory depression. In addition, these high doses can be used when indicated without the fear of hastening the deaths of patients who are at the end of their lives.
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| darkhorse
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CCCCC...this is palliative care......midazolam will significantly reduce pain and agitation.....this is standard practice to give morphine and midazolam to terminally ill patients
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| deja_vu
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B. You can't give high dose Morphine to "KILL" the patient even if patient insist that but You can give Morphine to any dose in terminally ill pt to "relieve the pain" even if doing that may actually kill him. [patient should be warned regarding this before giving,,off course].
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| Lim
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is it A or B?
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| Korotkoff
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what is the answer?
Die with dignity works in Oregon. I am not sure if it works nationally.
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