NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5310

POLICIES AND PROCEDURES

Subject: Medical Direction

Associated Policies: 5322, 5422 02/05/98

1. Class:

1. Opiate (narcotic). Natural opium alkaloid.

2. Indications:

1. Ischemic chest pain.
2. Acute pulmonary edema.
3. Burns without hypotension.
4. Isolated extremity trauma.

3. Therapeutic Effects:

1. Promotes analgesia, decreases pain perception and anxiety.
2. Increase venous capacitance and reduces systemic vascular resistance.
3. Decreases myocardial oxygen demand.

4. Contraindications:

1. Absolute:

1. Hypersensitivity.
2. Hypovolemia.
3. Head injury.
4. Undiagnosed abdominal pain.

1. Relative:

1. Hypotension.
2. Compromised respirations, except pulmonary edema.

5. Adverse Effects:

1. Respiratory depression.
2. Decreased level of consciousness.
3. Transient hypotension.
4. Bradycardia or tachycardia.
5. Nausea and vomiting.

6. Administration and Dosage:

1. Adult: 2 to 5 mg slow IV over 1 to 5 minutes until desired effect is achieved. Intramuscular (IM) 5 to 15 mg.
2. Pediatric: 0.05 to 0.1 mg/ kg slow IV (Maximum 2 mg single dose) over 3 to 5 minutes. May repeat every 5-10 minutes at 1/2 dose until desired effect is achieved. IM 0.1 mg/ kg every 3-4 hours.
3. Infant under 6 months (est. 8 kg): 0.05 mg/ kg slow IV over 3 to 5 minutes. May repeat every 5 to 10 minutes at 1/2 dose until desired effect is achieved.

7. Special Information:

1. Place all patients receiving MS on cardiac monitor and pulse oximetry if available.
2. Patients receiving Morphine should always receive supplemental oxygen.
3. Excessive narcosis can be reversed with IV Naloxone.