Saturday, March 15, 2008

Calling all Parents with Medical Knowledge......

Rhett is allergic to Morphine. When he has his surgery on Friday he will need heavy pain meds. That being said, last time he was given an alternative for Morphine it was Dilaudid.

BUT.....that is the medication that he was overdosed on. It is a very concentrated opioid, much more than Morphine, and it isn't used very often in pediatric patients. I know that the hospital has told us that the pharmacy has changed the labeling on it, so that it is easier to do the conversions, but I still don't want him on it.

I know in the past they have used Versed, Fentanyl and Precedex, but those are more sedatives. We have no idea whether or not he will stay intubated after the surgery, but if not, then I know they won't want to give him too much sedation, due to his lung issues.

Again I am freaking out. I don't think I am ready to return to the PICU.

12 comments:

Kari said...

I don't have any advice. I had a really bad reaction to demerol post surgery one time but Morphine has always been fine for everyone in our family. How about Demerol? Is he allergic? Since it is a synthetic version of Morphine I was just thinking maybe he might not be. I can't even imagine what your going through. I have severe anxiety when I step into our Childrens Hospital. My heart goes out to you and your in my prayers every Day!!!

Megan said...

I wish I had some advice for you on another med besides morphine...Alyvia was on all those other drugs and they seemed to do alright...but like you said they are sedatives.

I saw the Princess pics!! They are so cute, glad Chloee got to do it! Looks like she had a blast.


Also, my little bro buises really bad too--like a peach! You should see him during football season, he looks like someone literally beat him up. He doesn't have any explanation behind it, he just bruises really easily.

We are thinking of you guys and Rhett's upcoming surgeries. Your family is in our prayers.
Stay strong! You are such a good mom to Rhett!

Marla said...

Hugs and Prayers. I know nothing about these medications. I am sorry. Hang in there.

Niksmom said...

Call your pediatrician FIRS THING Monday and ask them to discuss this with you. In addition to that, call the Patient Relations office at the hospital and tell them the issue and ask them to have the anesthesiologist to call you to discuss. If there IS an alternative, I would make it clear that you will not sign the consent forms for them to use the Dilaudid. Yes, it might make you seem like a PIA but...

Mayte said...

Hi Pam. I asked a pain management anesthesiologist and he told me to look up Toradol and Demerol, and basically non-steroidal anti-inflammatory. But he says that Dilaudid should do the work, because it wasn't the drug, it was the people. We always pray for Rhett and your family.

Anonymous said...

I am a RN and 1mg of dilaudid is equivalent to 7mg of morphine - make sure the nurses are extrememly careful and monitor his resp. rate and depth often


www.med-i-card.com

Sis Sarah said...

I was thinking demoral too. They used it on me when I had a scope done, knocked me out cold.

Lauriann said...

Hi Pam,
I would call and talk to the doctor and let them know all of your concerns with the medication ... good luck ... lots of hugs to you all .....

Childlife said...

Hi Pam -

I know you're getting all kinds of advice, but I'll tell you what I do when J's in the hospital, and you can take the info for what it's worth...

I'm a hospital pharmacist and when J is in the hospital, I absolutely refuse to let her be on morphine, dilaudid or on demerol. I find that she is too sedated on morphine, the nurses in pedatrics are unfamiliar with dilaudid and so it is high risk for dosing errors and the demerol hangs around in the body for a very, very long time and can be difficult to deal with if there are problems. I'v also found that J has very poor pain control while on morphine and on demerol. The dilaudid works, but to me, it just isn't worth the risk if you get a nurse that is unfamiliar with it and not paying attention.

I always insist that they use fentanyl for Jacqui's pain control for three main reasons: It is cleared by the body more quickly than the other three, so it is easier to deal with counteracting it if there are complications, the pediatric nurses are more familiar with it and less likely to make errors, and lastly, J tends to be less heavily sedated while on it so we've had much less breathing problems with her on the fentanyl and she also seems to have an easier time weaning off of it and better control of her pain while on it.

Hope that helps a bit...

I'll be keeping you much in my prayers!

Michelle @ In The Life Of a Child

Childlife said...

P.S. The other nice thing about fentanyl is that if he has to be on a ventillator for any period of time, it can be combined with versed (which also clears out of the body very quickly if there are problems) to get a real sane level of sedation while on the vent.

The main problem we have had in the past is getting doctors to listen to us about the size of the dose it takes to get her comfortable (because she has had so many surgeries it takes a fairly hefty dose to sedate her). It always makes me crazy that they insist on starting on the lowest dose and titrating up which translates to 3-4 hours before she is finally comfortable on the vent and means that she gets lots of unnecessary bolus doses which make it a much more difficult to finally wake her up when they decide to wean her off the vent. I now keep copies of her Medication Administration Record from past hospitalizations showing her fentanyl and versed dosing required to manage her pain and to keep her sedated while on a ventilator. I take them with me to the initial surgical consults and make sure we have a pain control plan that is already agreed on and in writing before the surgery date. It has made things go much more smoothly. Wishing you all well!

Michelle @ In The Life Of A Child

Kei said...

(((HUGS)))

The Wiley Family said...

Cohen gets really itchy with morphine so they said they could use something else that starts with an L. I will find out tomorrow what it is. Also after surgery when the morphine made him too itchy to handle they switched him to toradol. That worked really well and he didn't complain about pain at all. I'm not sure if that one would work when he needs heavy pain meds but they have a team that only deals with pain meds and so they should be able to make Rhett quite comfortable.