Page 55 - ATP-P 11th Ed

Pain Management (Analgesia and Sedation)
Background
A provider of PCC must first and foremost be an expert in TCCC and then be able to iden- SECTION 1
tify all the potential issues associated with providing analgesia with or without sedation for
a prolonged (4–48 hours.) period.
These PCC pain management guidelines are intended to be used after TCCC Guide-
lines at the Role 1 setting, when evacuation to higher level of care is not immediately
possible. They attempt to decrease complexity by minimizing options for monitoring,
medications, and the like, while prioritizing experience with a limited number of options
versus recommending many different options for a more customized fashion. Furthermore,
it does not address induction of anesthesia before airway management (i.e., rapid sequence
intubation).
Remember, YOU CAN ALWAYS GIVE MORE, but it is very difficult to take away.
Therefore, it is easier to prevent cardiorespiratory depression by being patient and me-
thodical. TITRATE TO EFFECT.
Priorities of Care Related to Analgesia and Sedation
1. Keep the casualty alive. DO NOT give analgesia and/or sedation if there are other pri-
orities of care (e.g., hemorrhage control).
2. Sustain adequate physiology to maintain perfusion. DO NOT give medications that
lower blood pressure or suppress respiration if the patient is in shock or respiratory
distress (or is at significant risk of developing either condition).
3. Manage pain appropriately (based on the pain categories below).
4. Maintain safety. Agitation and anxiety may cause patients to do unwanted things (e.g.,
remove devices, fight, fall). Sedation may be needed to maintain patient safety and/
or operational control of the environment (i.e., in the back of an evacuation platform).
5. Stop awareness. During painful procedures, and during some mission requirements,
amnesia may be desired. If appropriate, disarm or clear their weapons and prevent ac-
cess to munitions/ mission essential communications.
General Principles
Consider pain in three categories:
1. Background: the pain that is present because of an injury or wound. This should be
managed to keep a patient comfortable at rest but should not impair breathing, circula-
tion, or mental status.
2. Breakthrough: the acute pain induced with movement or manipulation. This should be
managed as needed. If breakthrough pain occurs often or while at rest, pain medication
should be increased in dose or frequency as clinically prudent but within the limits of
safety for each medication.

44 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 45