Avoid giving intramuscular pain killer for chest pain

It’s a common practice in healthcare centers that patients are given intramuscular pain killer for pain, specially if it’s muscular.

The injection used is mostly dicloran. The advising doctor may advice it as:

inj dicloran i/m stat

The statement means that this patient should be given the medicine “dicloran” in the injection form through intramuscular form, once only (stat).

Please note that there can be various other medicines for various other reasons that are given intramuscularly too, diclo was just an example.

Isn’t intramuscular injection useful?

Now don’t get me wrong, the injections are very useful intramusuclarly and are very much needed in certain patients. The purpose of this post is to bring out the awareness that the intramusuclar injections should be “Avoided” (not as absolute contraindication) in patients with chest pain, at least unless they’re diagnosed and any heart related issue ruled out.

Why not to administer intramuscular injection in chest pain

Patients complaining of chest pain might be going through some cardiac event, with damage happening to their heart muscle. The issue with it is that the cardiac markers, CK-MB, are evaluated in blood to help in diagnosing the heart disease or its extend. However, if an injection is delivered intramuscularly, it will itself result in raising the CK levels in the blood.

Some studies show that the rise is not always seen with intramusuclar injections. However, it should still be avoided if it can be.

Also, if a patient with chest pain who received an intramusuclar injection is found to have raised ck-mb levels, he should be managed with suspicion of cardiac event and the levels of CK with CKMB should be correlated for diagnosis.

Another reason to avoid intramusuclar injection in those patients is that if they’re suffering with cardiac event, they’re most probably going to receive clexane or streptokinase, which are going to enhance the bleeding at the site of injection, resulting in unexpected complication.

Please note, that the decision of which drug to use and through which route lies totally with the treating doctor and thus it’s important to discuss and get the patient managed with the expert who understands the pros and cons of all medicines and the outcomes of each condition.

Sometimes the condition of the patient is critical and risk has to be taken to save patients life or function of the heart and thus aggressive treatment is preferred. In some other cases, the physician concludes that the injection might not affect the health of the patient if any thrombolytic agent is administered, even if they’ve received an intramuscular injection.

So the take home message is to avoid intramuscular injection in the patient coming to you in emergency room with chest pain. They might be coming with any cardiac event and this injection may result in misdiagnosis or mismanagement or complications in the patients, resulting in unexpected results. However sometimes the administration of the intramuscular injection becomes important and should be done after consulting the specialist or expert available.

Please let me know what’s your experience regarding this issue in the hospital and what protocols do you follow?