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Intranasal fentanyl or diamorphine versus intravenous morphine for analgesia in adults

Report by: Lee Helliwell, SpR in Emergency Medicine

Search checked by: Catherine Jackson, SpR in Emergency Medicine

Institution: Lancashire Teaching Hospitals NHS Trust, Lancaster Teaching Hospitals NHS Trust, Lancaster, UK

Clinical scenario

It is 07:45 and you are just winding down with a coffee before the end of a shift and the doors to the Emergency Department (ED) burst open. Lying on a stretcher is a young, obese lady who is screaming in agony. She has an obvious fracture dislocation of the ankle. Just when you thought things couldn't get any worse, the paramedics inform you that she has no visible peripheral veins and securing peripheral venous access has not been possible on previous hospital admissions. While you evaluate your …

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