Page 173 - ATP-P 11th Ed

PROCEDURAL ANALGESIA PROTOCOL

SPECIAL CONSIDERATIONS SECTION 1
1. Intended for performing brief, significantly painful procedures such as chest
tube insertion or fracture reduction.
2. Prior to initiating this protocol, the following should be accomplished:
a. Vascular access
b. Airway equipment, suction, and bag valve mask device immediately avail-
able and with reach.
c. Monitoring equipment (if available) on and attached to patient (if tactically
feasible).
3. Concomitant administration of narcotics and benzodiazepines increases the
risk for respiratory depression and hemodynamic instability. Use caution. Do not
use in patients with shock or hypotension.
4. Once the protocol has been initiated, monitor patient vigorously.

Single Agent
1. Morphine 5mg IV/IO q5min to a maximum total dose of 30mg. Repeat every
30–60 minutes as necessary.
2. In the event of respiratory depression, administer naloxone (Narcan ) in 0.1mg IV/IO
®
increments until respiratory effort is adequate.
Dual Agent
1. Midazolam (Versed ) 2mg IV/IO over 1 minute, followed by 0.5–1mg increments
®
after 5 minutes to a maximum total dose of 4mg.
®
2. PLUS Ketamine (Ketalar ) 20mg IV/IO over 1 minute, followed by 20mg incre-
ments every 30–60 seconds until nystagmus occurs or a maximum total dose of 100mg.

Disposition
Determine disposition based on the underlying etiology that necessitated the pro-
cedure performed.

162 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 163