02-21-2009, 03:07 PM
Seven days after sustaining partial- and full-thickness burns in a house fire, a 7-year-old boy has brain asphyxia, acute respiratory distress syndrome, multiorgan system failure, and sepsis. He is being mechanically ventilated. After consultation with his parents, a do-not-resuscitate order is written, and the boy is removed from the ventilator. Twenty minutes later, his blood pressure is bp86/42 mm Hg, pulse is 130 min. and respirations are 8/min. He periodically moans in pain. His current pain medication is intravenous morphine (20 mg/h). Which of the following is the most appropriate next step in pain management?
O A) Decrease the morphine until the patient's respirations are greater than 12/min
O B) Increase the morphine
O C) Administer midazolam
O D) Administer naloxone
0 E) Administer pancuronium
Here the answer given is B
However, I think it's A
B is incorrect, I think
If we give more morphine, he will have even more resp depression which will lead to
a help in death of this pt. d/t severe resp depression. Although he has DNR signed, DNR does NOT mean active help in dying like giving more morphine cauding respiratory depression severe enough for death.
C is not correct, coz this can also cause resp depression
D will reverse the morphine effect completely but this pt needs opiate for pain control so not D
E is not correct beczuse he's not undergoing intubation
So I think the answer shud be A
First we need to decrease the morphine so the resp rate cud be elevated to 12/min
and during this time, we cud give the patient something that has less resp depessive effect
What do u guys think??
O A) Decrease the morphine until the patient's respirations are greater than 12/min
O B) Increase the morphine
O C) Administer midazolam
O D) Administer naloxone
0 E) Administer pancuronium
Here the answer given is B
However, I think it's A
B is incorrect, I think
If we give more morphine, he will have even more resp depression which will lead to
a help in death of this pt. d/t severe resp depression. Although he has DNR signed, DNR does NOT mean active help in dying like giving more morphine cauding respiratory depression severe enough for death.
C is not correct, coz this can also cause resp depression
D will reverse the morphine effect completely but this pt needs opiate for pain control so not D
E is not correct beczuse he's not undergoing intubation
So I think the answer shud be A
First we need to decrease the morphine so the resp rate cud be elevated to 12/min
and during this time, we cud give the patient something that has less resp depessive effect
What do u guys think??
