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Agree +++ with giving analgesia to abdo pains. I keep a copy of the relevnt article (you know the one, analgesia doesn't mask the diagnosis, tends to improve diagnostic accuracy if anything) in A&E, to wave under the nose of any surgical SpR who cares to argue the toss with me. I've stopped bothering to ask them if they would mind if I gave some analgesia while they were waiting to be seen - the answer was always: "No, rather you didn't, old chap, we'll be there in a minute anyway". Three hours later and still waiting.... Now I give them analgesia 1st, refer the patient 2nd and discuss it with the surgeons later. >Morphine. I'm fairly mean with anti-emetics in younger people as the >incidence of dystonic reactions is rather high. I tend only to give >them to those who are very nauseated or have actually vomited. I've never seen a dystonic reaction at any age after a single shot of metoclopramide, and I routinely use it in everyone I give morphine to (irrespective of age or sex). That's not evidence, but it is my experince. I await the list's combined anecdotal evidence to the contrary with fevered anticipation. The BNF/data sheet states that dystonia is more likely in young females, but doesn't go so far as saying its contra-indicated for this reason. One of the "allowed" indications for metoclopramide in the young is as a "pre-med" (to increase gastric emptying). I have always taken the view that the cautions in the data sheet etc. are aimed mainly at disuading regular dosing of metoclopramide in the young, and quite rightly too. Personally I think the potential benefits of reducing the risk of aspiration related to an urgent GA for, say a kinky wrist #, outweigh the small risk of dystonia which, though unpleasant, is not life- threatening, is easily and quickly reversed and is pretty rare (I reckon) after a single dose. That's quite apart from the humanitarian aspect of reducing nausea and vomiting, whether induced by pain or morphine. If the kid still needed morphine on the ward later, I would be very reluctant to continue metoclopramide. I think our kids ward uses domperidone supposotries, if needed. Any one got any hard facts (to educate my clinical impression) on: 1) incidence of vomiting post-morpine in kids 2) " " " " " if given anti-emetic too 3) " dytonic reactions after 1 dose of metoclopramide.