administering Morphine

Ive got most of the field manuals on first aid and medical stuff. I'm having a hard time locating information on the proper use of the morphine syrette as it relates to location of the wound. Ive heard people talking about injection points for certain wounds, etc.

Does anyone have any info on where medics were instructed to place the morphine in relation to the wound ?

 

This is what I found in the net:

"Recommendations for injection are to use that part of the body which can be most quickly and easily exposed, such as the loose skin of the abdomen, the thigh, or the upper arm, and to prepare the skin with iodine or alcohol. "

WW2 US Medical Research Centre :: Miscellaneous Medical Equipment - Morphine

 

Morphine works on the whole body to ease pain, and the injection site relative to a wound for relief isn't important. While it might offer some earlier relief, I doubt it. It's not like something used for local relief like novocaine. Not sure if that is your reason for asking.

 

Maybe that´s another gossip that went around among the soldiers... I know there must have been a million of them

 

Wasn't there a saying like "one for comfort, two for eternity" or something like that with using morphine doses? Or am I just making this up?

 

Like any drug, you can overdose on it which can kill you. It sends you to lala land. I don't know its exact properties or how it makes you feel, but its highly addictive and is still used today to treat extreme forms of pain (a morphine drip, for instance). I'm not sure the size of the doses used in WW2, but I would imagine that 2 - 3 in quick succession would not be good use for the patient, unless just to ease his pain before death.

 

Having been given morphine many times over the years as I don't react well to other drugs, I can tell you that the dosage shown on the pictures in that referenced article is a pretty low dose in one shot as I've been given considerably more, but that was in a closely monitored hospital environment and by IV.

My suspicion is that they had to choose a dose that would offer some pain relief, but take into consideration how it would be used. A quick shot to someone who has not been evaluated or would not be monitored to prevent overdoses until some time in the future. Depending upon the condition of the person being given the drug (severity of wound and overall condition), it probably could be easy to accidently kill someone who is in pretty bad condition with multiple doses, as it slows respiration and I believe drops your blood pressure to potentially dangerous levels in someone in shock. Someone who is not in bad shape could tolerate higher doses without much trouble, although how much is safe requires at least some medical knowledge and monitoring.

 

Because of the respiratory suppressive effect of Morphine, you use the minimum dosage to suppress or take the edge off the pain. Upon administration of morphine you are and were supposed to mark the patient as having been given morphine. You would place an "M" on the forehead, even using the patients blood if no other method of marking is available. You would then note the time on a casualty tag, if no tag was available or time did not permit the time was noted on the forehead also. The styrette should then be attached to the patients uniform so that medical personnel providing follow on care know exactly the dosage administered. Morphine would be administered intramuscularly, IM, you can use any large muscle, preferably the thigh, deltoid, triceps or buttocks because these are large muscles with good vascularity which leads to fairly rapid absorption of the medication and distribution via the cardiovascular system. In a hospital environment where closer monitoring of vital signs is possible morphine can be administered intravenously, IV, or directly into the blood stream.
A second styrette could be administered but should not be done before a patients vital signs can be taken and evaluated to determine a patients stability.

 

Thanks for the info. Is it true that you are not supposed to administer morphine for a wound above the heart ?

 

Not quite sure as to the meaning of the question. If you are asking about a wound anywhere higher than the heart, I don't think there would be a problem unless it's a brain injury where there is a possibility that the dulling effect could make evaluation more difficult. If you couldn't use it for pain in that area at all, it would leave a lot of the body where you could not offer any help in the event of an injury.

If you are asking about a wound located close above the heart, and if the morphine might stop the heart, I doubt that there would be a problem, as the nerves regulating the heart are deep inside the heart. Remember morphine is systemic not a local.

I'm not a doc, but know a little about the heart. Had to learn the hard way.

 

I might be missing something but why cant morphine be used for head wounds or concussions ? What does morphine do that could kill a victim ?

 

From Wikipedia:

Contraindications

The following conditions are relative contraindications for morphine:

• acute respiratory depression
• renal failure (due to accumulation of the metabolites morphine-3-glucuronide and morphine-6-glucuronide)
• chemical toxicity (potentially lethal in low tolerance subjects)
• raised intracranial pressure, including head injury (risk of worsening respiratory depression)
• Biliary colic.[22]

It's primarily the risk of reducing respiratory function in the patient. i.e. they quit breathing or their heart just stops beating. The link below while couched in medical speak explains one of the processes that leads to this effect.
Problems With Morphine Use in Patients With a Severe Brain Injury - Full Text View - ClinicalTrials.gov

 

Thanks for the info. I was browsing my 21-11 field manual and it doesnt explain this it just says dont do it.

 

I know that this topic has been covered, and this is a very late reply, but to answer nobody73's question as to why you don’t administer morphine to a patient with head trauma can be a very complicated answer. First, you need to realize that the medics in the field don't have the availability or resources that your run of the mill doctor, or surgeon will have, so field medicine is very different than hospital medicine. The field medic has to assume that the injury is the worst possible it could be. Knowing that, next you have to look at the actual physiological responses within the body, i.e. how morphine affects the body, and how a head wounds affects the body.
A soldier, sailor, marine, or airman that suffers a head trauma in the rear will have access to a doctor who can run tests to see what is actually affected, i.e. just a concussion, or is there internal bleeding, or could it be something else. One of the worst things that you can have is internal bleeding in the head or what is called a subdural hematoma, or intracranial hemorrhage. A field medic, unless they have specialized training, will not be able to manage this for very long. If you understand the anatomy of the skull, you will know that there isn’t that many ways to get out, all except one, the foramen magnum, or the large hole at the base of the skull. When, and if enough pressure builds up due to hemorrhage, the brain could possibly push out of the foramen magnum. At the base of the brain is your respiratory center, which will try to push its way out lowering, or just stopping your respiratory drive. Now, with a head trauma, the patient might not be in the right state of mind, or what is commonly referred to as altered level of consciousness or ALOC. So now your patient at worst could have an ALOC, intracranial hemorrhage, and respiratory distress. That sucks!
Next lets look at what morphine does to the body. Without getting into the nitty gritty of pharmacology, and the mechanism of action of morphine, we will just look at what morphine does in layman’s terms. Morphine will bind with the opioid receptors in the brain reducing pain, and causing euphoria. (Like I said, layman’s terms) Morphine is also a respiratory depressant, so it suppresses or reduces the respiratory drive of your patient. (I know this from experience) Another side effect of morphine is that it will actually increase intracranial pressure, and lowers blood pressure.(I know that Slipdigit said it doesn’t effect the heart, but it does)
So, now we know that morphine can suppress respiratory drive, increases intracranial pressure, and can cause euphoria (a form of ALOC). Head trauma can increase intracranial pressure, decrease respiratory drive, and can cause an ALOC. With this info we now know that if you push morphine on a patient with head trauma, you could potentially turn a bad situation into a very bad situation.
This is a very simple explanation, and there is much more that you have to contend with when pushing and opioid like morphine, or any opioid for that matter. If you would like to know more, please feel free to ask, I will impart what ever knowledge I can, but realize that you should never use this knowledge unless you get trained and certified by a professional that can certify you.

 

Good reply and welcome aboard!

 

I have read that if a soldier suffered an obviously non-survivable wound and was in a lot of pain, some medics/doctors would overdose him literally to "put him out of his misery" and to ease his passing. Naturally, this wouldn't be covered in the field manuals. Perhaps this is the origin of the "one for pain, two for eternity" quote in ULITH'S post.

 

There is a lot of Hollywood misinformation around morphine injections. An IM injection takes about 15 minutes before the effect is felt and about 45 minutes before it is fully active. In movies, they always show immediate relief.
Also, you don't want to give an IM injection anywhere near the wound, or below a wound on a limb, for the simple reason that blood supply is compromised in that area - they won't get any relief from the pain, or very little. Ideally, you want to place the shot in a large muscle on the opposite side of the body from the wound. The only rule is that it must be inside a muscle, because if you release the drug into fat or between muscle groups there is no rapid blood supply to carry the drug to the CNS system.

I don't remember what documentary I saw this on, but an old WWII vet was talking about being wounded and the medic gave him a morphine shot in the "strategic spot" that saved his life. That kind of sums up the general misinformation on the subject. There is no strategic spot other than a muscle, and it won't save your life - it's just pain relief. One might argue that since morphine is a cns depressant, that slowing your heart and breathing might also slow blood loss and I suppose that's true, but the effect would be negligible in most cases.

 

Maybe by "strategic spot" he meant the ol' gluteus maximus.