Page 271 - ATP-P 11th Ed

PAIN MANAGEMENT PROTOCOL

SPECIAL CONSIDERATIONS
1. Any use of narcotic medications will be sedating and degrade the mission per-
formance of patients.
2. Avoid IM or SQ injections of narcotic medications due to the potential for de-
layed absorption.

Signs and Symptoms SECTION 2
Pain
Management
1. Start in sequential manner to maximize pain control with mission performance.
a. Mild analgesic
i. Acetaminophen (Tylenol ) 1000mg PO q6hr prn (Mild to moderate pain-
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patient is still able to perform.)
ii. OR acetaminophen (Tylenol ) 650mg bilayer caplet, 2 PO q8hr (found in the
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TCCC Combat Wound Medication Pack [CWMP])
b. Nonsteroidal anti-inflammatory drugs (Mild to moderate pain-patient is still able to
perform.)
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i. Meloxicam (Mobic ) 15mg PO qd prn (found in the TCCC Combat Wound
Medication Pack [CWMP])
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ii. OR ibuprofen (Motrin ) 800mg PO q8hr prn
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iii. OR ketorolac (Toradol ) 30mg IM q6hr prn, not to exceed 120mg/day
®
iv. OR ketorolac (Toradol ) 60mg IM single dose or 30mg q6hr prn; not to
exceed 120mg/day
c. Narcotic Medications (Moderate to severe pain. Consider disarming the patient.)
i. Oral transmucosal fentanyl citrate (Actiq ) lozenge 800mcg orally over
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15min (may repeat dose once)
Life-threatening hypoventilation/respiratory arrest could occur at
any dose of fentanyl, particularly in patients not taking chronic narcotics.
Therefore, closely monitor for respiratory depression.
ii. OR morphine sulfate 5mg IV initial dose then 5mg IV q10min for max
dose of 30mg. Repeat as necessary q30–60min.
d. Disassociative anesthetic (Moderate to severe pain. Disarm the patient!)

260 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 261