This is deeply illogical. If Nubain was contra-indicated then so was diamorphine! I won't get on my high horse about nalbuphine
again, save to comment that it is only a partial agonist and hangs around for a very long time; its excretion half-life is 222 minutes (ref
available if required) and diamorphine has a half life of around 150 minutes. Diamorphine can be completely reversed by naloxone,
whereas nalbuphine cannot.
Having said all that, the doses Sussex allow their paramedics to use are so small that there would have been no perceptible change in
any parameter. We had a patient brought in with a # dislocation of the right ankle a few days ago who had been given 5mg!
The contraindication to nitrous oxide (N2O) is also pretty pointless except in the rather rare and obvious case of pneumocephalus.
Best wishes,
Rowley Cottingham
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