Page 22 - 2026 SMOG

PAIN MANAGEMENT
History
• Patient vocalizes and/or signals pain
• Tachycardia
• Diaphoresis
• Elevated blood pressure
Treatment
(Continued from UNIVERSAL PATIENT CARE PROTOCOL
or TACTICAL EVACUATION PROTOCOL)
• Minor Pain (0–3 pain scale)
˚ Acetaminophen
■ PO: 1g q6–8hr prn (max 4g in 24hr)
• Moderate to Severe Pain (4–10 pain scale)
˚ Ketorolac: Adults <50kg
■ IV: 15mg q6hr (max 60mg)
■ IM: 15–30mg q6hr (max 60mg)
˚ Ketorolac: Adults >50kg
■ IV/IM: 15–30mg q6hr (max 120mg)
˚ Morphine: Chest Pain/AMI
■ IV/IO: 1–5mg
˚ Morphine: Acute pain
■ IV/IO: 2.5–10mg q1–4hr prn
˚ Ketamine:
■ IV/IO: 0.1–0.3mg/kg q10–30min prn
■ IM/IN: 0.5–1.0mg/kg q10–30min prn
˚ Hydromorphone:
■ IV/IO: 0.5mg (range 0.25–2mg) q1–6hr prn
˚ Fentanyl:
■ IV/IO: 0.5–1mcg/kg q30–60min prn
■ IM/IN: 1mcg/kg (if IN max 100mcg/dose, max 50mcg per nostril)
Notes, Cautions, Warnings
• Ensure vital sign monitoring on all patients receiving pain medications.
• Recommend starting with a low dosage of pain medications and titrating upward to the
desired effect.
• Do not use PO medications in any patient with altered mental status or anyone in whom surgery
is anticipated, unless directed by the transferring provider.

14 • GENERAL