Welcome to my first installment of a section where I share some knowledge and experience that I hope helps you become a better doctor.
"You can always give more."
A common phrase in medicine when starting or changing a medicine in the elderly is "Start low, go slow." My phrase applies to patients of all ages, and it comes from a perspective of safety, narcotics in particular.
Patients respond to the same medicine differently, different surgical procedures carry differing amounts of post op pain with them, and the danger of respiratory depression with narcotics is very real.
It takes time to get comfortable with near high to high doses of medicine when you're starting out. It's easier to give more medicine in small doses, like morphine or hyrromorphone for example in a titrated way than to get the naloxone out and start managing compromised respiratory drive, especially in someone who might have COPD or other pulmonary or cardiac diseases. There have been a few instances of people going apneic or near apneic with small doses of hydromorphone or morphine, usually in more older and debilitated patients. It's a good phrase to live by.
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