LIN Sessions – IV Opioids Can Be Dangerous

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Michael V. PA -

It seems like this section makes a good case for using low dose Ketamine in conjunction with lower dose opioids for analgesia in certain groups of patients.

Donald W. C., M.D. -

I listened with interest to this presentation but must say that, in the final analysis, I very much disagree with the tone and implied message here that IV opiates are dangerous. Like all studies of adverse reactions we must ask the question, "what is the denominator?" I have had over 250,000 patient encounters in my 32 year career and for every one of the very few serious adverse reactions I've seen, I've seen hundreds of pts suffer from inadequate analgesia. I'm not suggesting that we blast octagenarians with 2 mg dilaudid without caution, but for 95% of young relatively healthy people this is a reasonable dose. The notion that the need to reverse an opiate's effect reflects a disasterous outcome is wrong. Giving medications and then ignoring a patient is wrong. The problem here is that an inexperienced physician may listen t
o this presentation and come away with the idea that it is better to limit the amount of pain medicine to protect the patient (but really themselves) instead of giving enough pain medicne to acheive the appropriate result

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