My view is that she is alert, but has severe pain that needs relieving by
opiates. The beauty of opiates is that they are rapidly reversible if it
goes pear-shaped, so I would not hesitate to give nubain etc in this case.
I still hear the old-fashioned dogma that opiates interfere with pupil size
& therefore should not be given to head injured patients because it makes
their assessment more difficult.
What does your protocol say? Does it need reviewing?
Dr John Apps
BASICS North East
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