Re: Syncope and hiccups

[Guest guest]

,

I had that same type of conversation with my grandmother's oncologist.

She was mets to the bones and brain at least and the doc was saying she

could live 10 years like this! I couldn't believe that statement, but the

doc had put her on hospice which is supposed to be terminal with 6 mos or

less to live. So, I'd asked for morphine titrated to comfort (before the

days of pt. pumps for pain meds). The doc said no, she may become addicted!

I lost it and explained that she may have missed this class in med school,

but my grandmother was 70 yo, terminal without a doubt, and she had no

reason to be in pain the last few days, months, years of her life! I

shouldn't have handled it the way I did, but Grandma did get the Morphine

and got it whenever she asked (or we asked for her!).

Sometimes you have to take care of those who took care of you!

Jana

Re: [texasems-L] Syncope and hiccups

> Well, from a JCAHO stand point we are meeting their mandate to relieve a

> patients pain, so this is good.

>

> From the 'do no harm' stand point, assuming acceptible vitals, we are

making

> the patient feel better, which is doing not harm, thus this is good.

>

> From a psychological stand point the patient is REALLY happy to no longer

be

> hurting, which should have the physiological effects of a> lowering their

> BP, heart rate, and respiratory rate (I am late on this scenario so don't

> know if that might be an issue, if their bp was low I might not want to do

> this) as well as decreasing the workload on the heart (which is currently

> deprived of oxygen/nutrients so decreasing its workload is good) and; b>

> dilating the coronary arteries thus increasing blood flow (and thus oxygen

> and nutrient flow) to the infarcted site.

>

> I think that about covers they why it would be good as well as the why it

> would be bad.

>

> From my own personal experience with kidney stone pain (which I have been

> told by a patient doesn't hold a candle to MI pain), I would NOT want to

be

> experiencing any pain of that magnitude for longer than I had to.

>

> As for the, " They might become addicted to the Morphine, so we should

> withold it " crowd, they have pretty much determined that patients in REAL

> pain, don't become addicted from the stuff very quickly and if they do,

they

> are alive to get treatment.

>

> Quick war story: Sitting in the ER one day when we get a phone call from a

> local pharmacist who wants doctor authorization to refill a Morphine

> prescription for a 92 year old cancer patient. The doctor doesn't hesitate

> in giving authorization. Pharmacist asks, " But she got this prescription

for

> 30 tablet (a 1-2 tablets tid for pain control) 5 days ago, I am worried

that

> she is becoming addicted. " Doctor looks at the phone and replies, " She is

92

> years old. She has terminal cancer. She is in pain, or at least believes

she

> is. Who cares if she is becoming addicted?! " The moral of this story,

" Make

> the pain go away. Keep the patient alive for as long as you can, but make

> the pain go away. " Does anyone on this list want to lay around in 10/10

> chest pain (or 9/10, or 8/10, etc) for any longer than they have to? Do

you

> want your last minutes on earth being spent in screaming agony? If the

> morphine won't cause an adverse physiologic action (IE: Death), GIVE IT!

>

> Okay, the soap box is someone elses.

> Webb, LP

> FLW EMS, MO

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