• Morphine administration is unchanged from previous in the ALS PCS v5.4​
  • It still carries a Condition of Normotension​
  • Morphine has more hemodynamic effects than fentanyl and therefore the Normotension Condition has been kept
• What HAS changed with ALS PCS 5.4 is the removal of the Clinical Conditions statement:​ "fentaNYL should not be used in combination with morphine unless authorized by BHP"​
• Therefore, within ACP scope, you can now administer fentanyl in combination with morphine, as long as the dosing interval is no earlier than the most recently administered medication dosing interval

Case Example

Case Example: 9-year-old with a fall off motorcross bike has an obvious deformity to right forearm. Patient is in severe pain. ​

Patient has previously broken their arm and "did not respond well" to fentanyl. However, did well with morphine in the past. ​

SBP: 104mmHg | HR: 120 | RR: 24 | Spo2: 98% | GCS 15​

*Normotension is calculated at 90+2xAge = 108mmHg​

Therefore, this patient does not meet the Conditions of the Medical Directive​

What treatment can you offer?

Case Review

• 9-year-old in severe pain due to trauma​
• Ibuprofen, Acetaminophen, Ketorolac all have the age Condition of 12 or older​
• Not "normotensive" to administer morphine​
• Had previous "bad reaction" to fentanyl​
• Ketamine (if approved by BHP patch) could be an option​
• Alternatively, could consult with BHP regarding best treatment options​
  • This may include exploring what the reaction to fentanyl in the past was, what the SBP is now to consider treatment etc.

 

If the patient does not meet the specifications of the Medical Directive, however you believe administration of morphine would benefit this patient, a BHP patch must be completed to consult a physician and receive an order. ​

**Note: There is mandatory patch point for morphine when the patient is < 12 years old

Summary

Morphine administration has NOT changed in the ALS PCS v5.4 and still carries the Condition of Normotension​

Should you believe that a patient may benefit from morphine administration despite not meeting the Conditions of the Medical Directive, a BHP patch must be considered to provide care outside of the Medical Directive.

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No additional resources available for this #SWORBHPTip.