LEARNING OBJECTIVE: Recall morphine dosage, administration routes, indications, contraindications, and casualty marking procedures.

As a Corpsman, you may be issued morphine for the control of shock through the relief of severe pain. You will be issued this controlled drug under very strict accountability procedures. Possession of this drug is a medical responsibility that must not be taken lightly. Policies pertaining to morphine administration are outlined in BUMEDINST 6570.2, Morphia Dosage and Casualty Marking.

MORPHINE ADMINISTRATION
Morphine is the most effective of all pain-relieving drugs. It is most commonly available in premeasured doses in syrettes or tubexes. Proper administration in selected patients relieves distressing pain and assists in preventing shock. The adult dose of morphine is 10 to 20 mg, which may be repeated, if necessary, in no less than 4 hours.

Morphine has several undesirable effects, however, and a Corpsman must thoroughly understand these effects. Morphine

is a severe respiratory depressant and must not be given to patients in moderate or severe shock or in respiratory distress.
increases intracranial pressure and may induce vomiting. These effects may be disastrous in head injury cases.
causes constriction of the pupils (pinpoint pupils). This effect prevents the use of the pupillary reactions for diagnosis in head injuries.
is cardiotoxic and a peripheral vasodilator. Small doses of morphine may cause profound hypotension in a patient in shock.
poisoning is always a danger. There is a narrow safety margin between the amounts of morphine that may be given therapeutically and the amounts that produce death.

causes considerable mental confusion and interferes with the proper exercise of judgment.

Therefore, morphine should not be given to ambulatory patients.

is a highly addictive drug. Morphine should not be given trivially and must be rigidly accounted for. Only under emergency circumstances should the Corpsman administer morphine.

Rigidly control morphine administration to patients in shock or with extensive burns. Because of the reduced peripheral circulation, morphine administration by subcutaneous or intramuscular routes may not be absorbed into the bloodstream, and pain may persist. When pain persists, the uninformed often give additional doses, hoping to bring about relief. When resuscitation occurs and the peripheral circulation improves, the stored quantities of morphine are released into the system, and an extremely serious condition (morphine poisoning) results.

When other pain-relieving drugs are not available and the patient in shock or with burns is in severe pain, 20 mg of morphine may be given intramuscularly (followed by massage of the injection site). Resist the temptation to give more, however. Unless otherwise ordered by a medical officer, doses should not be repeated more than twice, and then at least 4 hours apart.

If the pain from a wound is severe, morphine may be given when examination of the patient reveals no

head injury;
chest injury, including sucking and nonsucking wounds;

wounds of the throat, nasal passages, oral cavity, or jaws wherein blood might obstruct the airway;
massive hemorrhage;
respiratory impairment, including chemical burns of the respiratory tract (any casualty having fewer than 16 respirations per minute should not be given morphine);

evidence of severe or deepening shock; or
loss of consciousness.

CASUALTY MARKING
Morphine overdose is always a danger. For this reason, plainly identify every casualty who has received morphine. Write the letter "M" and the hour of injection on the patient's forehead (e.g., M0830) with a skin pencil or semi-permanent marking substitute. Attach the empty morphine syrette or tubex to the patient's shirt collar or another conspicuous area of the clothing with a safety pin or by some other means. This action will alert others that the drug has been administered. If a Field Medical Card is prepared, record the dosage, time, date, and route of administration.