The Effectiveness and Adverse Events of Morphine versus Fentanyl on a Physician-staffed Helicopter

Prevalence and Predictors of Prehospital Pain Assessment and Analgesic Use in Military Trauma Patients, 2010–2013

“…,75,94,95 but the distribution is similar to combat zone ED patients in World War II, 2011 and 2013 49,71,96. Similar to Gerhardt et al's finding 28 that 44% of records had severe or maximum pain scores, 42% of patients in this sample reported severe pain (7-10), but there was not sufficient documentation of pain reassessment to determine if pain treatment was adequate for these patients.…”

“…Similar to Gerhardt et al's finding 28 that 44% of records had severe or maximum pain scores, 42% of patients in this sample reported severe pain (7-10), but there was not sufficient documentation of pain reassessment to determine if pain treatment was adequate for these patients. Patients with very similar injuries reported widely differing pain scores, as found in previous studies of both military and civilian trauma patients 3,4,75,96,97. While we analyzed all available data, our model accounted for only 5% of the variance.…”

“…[72][73][74][75][76][77][78][79][80] Wedmore and colleagues 74 reported on 286 U.S. military combat trauma patients treated with fentanyl lozenges and found that both pre-and post-analgesic pain assessment scores were reported for 68.9%. Civilian trauma care researchers report PH pain assessment rates from less than 20% 4 to 73.4%.…”

Managing Moderate and Severe Pain in Mountain Rescue

“…Whether this finding can be generalized to all analgesics and other environments is unknown, though there is supportive evidence that higher pain levels are associated with higher rates of acute stress disorder and PTSD (Norman et al, 2008). No single drug is perfect for prehospital care but there is ample support that strong IV opioids (particularly fentanyl and morphine) or ketamine (with midazolam) given in a titrated manner are safe and effective in managing severe pain (Smith et al, 2009;Smith et al, 2012). Other IV candidates (e.g., weaker opioids such as tramadol, acetaminophen/paracetamol, and nonsteroidal anti-inflammatory drugs) may have a role in moderate pain (Cepeda et al, 2005;Craig et al, 2012).…”

Management of Pain in the Emergency Department

“…The drug has been around for as long as any other opioid and has excellent safety and efficacy when used appropriately. Despite theoretical and practical concerns about histamine release and hypotension, the use of morphine (including higher-risk patients such as cardiac and trauma cases) has not been associated with dangerous hypotension even in the relatively less controlled setting of prehospital care [173][174][175][176]. Some of the more interesting recent investigations of morphine in the acute care setting suggest that it may be combined with ketamine for increased efficacy (with minimization of hemodynamic risks) [143].…”