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Routes of Medication Administration

Question# 824

Route of admin for Morphine in ACS only includes IV in the PCS.

If IV access is unobtainable and nitroglycerin is contraindicated due to no history, I think it is reasonable to give morphine IM / SC for severe pain.

From a risk/benefit point of view, there seems to be very low risk and the benefit of reducing pain.

(I'm also aware that non-IV morphine has reduced vasodialotry effects and loses its potential nitro-like reduced pre-load features as a result).

Does base hospital share this view?

I'm aware I can always call BHP for guidance, but it would be helpful to know if I can simply chart my justification and be safe that way.

Answer:

Thank you for your recent MedicASK submission and your ongoing advocacy for patient care. It is important to follow the Advanced Life Support Patient Care Standards (ALS PCS) as it outlines the autonomous delegated medical acts paramedics can perform - even the routes of medication administration. That said, if you would like a standing order that falls outside of the ALS PCS a verbal order is required, and the Base Hospital Physicians (BHPs) are happy to engage in these patient-centred discussions.

We appreciate you bringing this matter forward. We are currently in the process of reviewing the ALS PCS Medical Directives at the provincial tables to ensure the best patient care. As paramedic practice evolves, your dedication to advocating for your patients is invaluable. Please remember that your BHPs at OMC are available to support you. The situation you describe is patient centered and as you said, the benefit outweighs the risk.

Keep up the great work and patient-centered approach! We strive to continue to advance the profession by identifying these gaps and improving patient care.

References

ALS PCS Analgesia and Cardiac Ischemia Medical Directives

Published

24 July 2024

ALSPCS Version

5.3

Views

119

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.