FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Severe pain or cardiac-origin pain not relieved by nitroglycerin within the applicable OCEMS pathway.
Contraindications & local exclusions
- Cited injection label: significant respiratory depression; acute/severe asthma without monitoring or resuscitation equipment; MAOI use now or within 14 days; known/suspected GI obstruction including paralytic ileus; morphine hypersensitivity. Apply OCEMS BP and population restrictions too.
Precautions
- Monitor breathing, consciousness and BP; additive depression with benzodiazepines/CNS depressants is a risk. Count prior opioid doses and distinguish vial concentration from the intended dose.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- Withhold if systolic BP is below 90 or falls below 90; adult injury/burn orders require BP above 90 before giving analgesia.
- Morphine is stocked in different concentrations. A matching milligram dose can require a very different volume.
Use in OCEMS
- Opioid analgesia for appropriate injury/burn pain and IV treatment of suspected cardiac pain after nitroglycerin fails or cannot be given.
- I-15 retains different adult doses for the 4 mg carpuject and 10 mg/mL vial presentations.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| Pain — IV/IM | 4 mg from the 4 mg carpuject, or 5 mg with the 10 mg/mL vial. May repeat once after about 3 minutes for persistent pain. |
| Cardiac pain | Use the IV route under SO-C-015 after 3 nitroglycerin doses fail or nitroglycerin cannot be administered. |
| IO in crush/burn injury | Only if already established for other treatment: 4 mg or 5 mg according to the preparation, with one repeat after 3 minutes as specified in I-15. |
Pediatric
- SO-P-015 severe injury pain: 0.1 mg/kg IV/IM, maximum 5 mg per dose. May repeat once after 3 minutes; total maximum 10 mg.
- Contact base for children age 2 or younger under SO-P-015. Check the pediatric condition order before using an IO route.
Pediatric weight table — Severe injury pain
- SO-P-015 pediatric dose: 0.1 mg/kg IV/IM.
- 0.1 mg/kg IV/IM, maximum 5 mg per dose. May repeat once after 3 minutes; total maximum 10 mg.
- Base contact is required for age 2 or younger. Match the product concentration and route: the I-20 examples distinguish IV carpuject products from the 10 mg/mL IM preparation.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IM | Volume at 1 mg/mL — IV | Volume at 4 mg/mL — IV | Volume at 10 mg/mL — IM |
|---|---|---|---|---|
| 3 kg | 0.3 mg | 0.3 mL | 0.075 mL | 0.03 mL |
| 4 kg | 0.4 mg | 0.4 mL | 0.1 mL | 0.04 mL |
| 5 kg | 0.5 mg | 0.5 mL | 0.125 mL | 0.05 mL |
| 6 kg | 0.6 mg | 0.6 mL | 0.15 mL | 0.06 mL |
| 8 kg | 0.8 mg | 0.8 mL | 0.2 mL | 0.08 mL |
| 10 kg | 1 mg | 1 mL | 0.25 mL | 0.1 mL |
| 12 kg | 1.2 mg | 1.2 mL | 0.3 mL | 0.12 mL |
| 15 kg | 1.5 mg | 1.5 mL | 0.375 mL | 0.15 mL |
| 20 kg | 2 mg | 2 mL | 0.5 mL | 0.2 mL |
| 25 kg | 2.5 mg | 2.5 mL | 0.625 mL | 0.25 mL |
| 30 kg | 3 mg | 3 mL | 0.75 mL | 0.3 mL |
| 35 kg | 3.5 mg | 3.5 mL | 0.875 mL | 0.35 mL |
| 40 kg | 4 mg | 4 mL | 1 mL | 0.4 mL |
| 45 kg | 4.5 mg | 4.5 mL | 1.125 mL | 0.45 mL |
| 50 kg | 5 mg | 5 mL | 1.25 mL | 0.5 mL |
| 60 kg | 5 mg | 5 mL | 1.25 mL | 0.5 mL |
Preparation & reassessment
- Confirm the concentration on the actual vial/syringe and record total milligrams.
- Reassess pain, respiratory effort, mental status, and blood pressure. Document dose times and response; maintain readiness for airway support.
UNDERSTAND THE CARE
Why matching milligrams does not mean matching syringe volume
The guide retains different adult instructions for the carpuject and vial presentations. Read the actual product and the relevant condition row before preparation. A familiar syringe appearance or container size should not substitute for checking concentration and the intended milligram dose.
Applying the guidance
For pediatric injury pain, use the formula, cap, permitted repeat and age-specific contact requirement together. Route authority still belongs to the condition order. Reassess pain, respiratory effort, consciousness and blood pressure after dosing, and include prior administration in the cumulative record. The response report should describe relief and tolerance, not only the dose delivered.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Condition
- Injury/burn versus cardiac-pain pathway.
- Product
- Carpuject/vial concentration and dose.
- Limits
- Route, repeat count, pressure and pediatric contact.
- Response
- Pain, breathing, consciousness and BP.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-C-015 — Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms
- SO-T-005 — General Injury and Trauma - Adult / Adolescent
- SO-E-005 — Burn (Thermal, Electrical, Chemical) - Adult
- SO-P-015 — General Injury and Trauma - Pediatric
- SO-P-095 — Burn (Thermal, Electrical, Chemical) - Pediatric
- Product label — MORPHINE SULFATE injection, solution
Account for the preparation and the total dose
Keep the drug amount in milligrams separate from the syringe or vial description. The guide preserves different adult instructions for the listed presentations. Report the actual preparation used and milligrams delivered, rather than describing treatment as “half a syringe” or “one vial.” Those descriptions cannot be interpreted safely without the concentration.
A repeat decision should include the earlier administration time, cumulative medication history, current pain, blood pressure and breathing. A request for more pain relief does not replace the indication-specific perfusion and repeat limits. When another crew takes over, transfer the record before a new preparation is selected.
For example, a patient received medication from a carpuject on scene and the transporting unit carries a different vial concentration. The new stock does not change what the patient already received or reset the treatment sequence. Confirm the appropriate condition row and route, then preserve both administrations clearly in the record. Pediatric weight-based instructions remain separate from either adult presentation.