Mu opioids: The key to safe ER analgesia

November 30, 2017
Garret Pachtinger, VMD, DACVECC

Dr. Pachtinger is an emergency and critical care clinician at Veterinary Specialty and Emergency Center in Levittown, Pennsylvania, and Philadelphia, Pennsylvania. He is also the chief operating officer for VetGirl.

Emergency, critical and trauma patients benefit greatly from these pain medications, says criticalist Dr. Garret Pachtinger.

Assessing a patient for proper medication is a crucial aspect of emergency medicine, says Fetch dvm360 conference speaker Garret Pachtinger, VMD, DACVECC. To this end, he uses the "ABCDs of triage medicine":

Airway: Does the patient have a patent airway? Upper airway or lower airway abnormalities?

Breathing: Does the patient have an abnormal breathing pattern? Is the patient dyspneic? Is there a rapid, shallow breathing pattern? Is there a slow, labored breathing pattern? Is there increased stertor or stridor?

Circulation: Is there an abnormal heart rate? Are the mucous membranes an abnormal color with evidence of internal or external hemorrhage? Are the pulses weak? Are the extremities cold?

Disability: Is there evidence of head trauma or other neurological injury?

While a patient may eventually benefit from treatment with an NSAID, Dr. Pachtinger says the patient may not always be instantly ready for one. Instead, he favors mu opioids.

More opioid resources

Hesitant to prescribe opioids? Here's why they're an excellent option.

Take a look at the acute pain pyramid.

Vanquish the 3 most common pain management mistakes made in surgery patients.

"Patients typically tolerate them very well, they're very effective, and the patient doesn't have significant changes that could affect the liver or kidneys," he says.

Dr. Pachtinger cites pure mu opioids such as hyrdomorphone, methadone, morphine and fentanyl as preferable until a patient is stable enough for other options.

Watch the video to hear more from Dr. Pachtinger.