Page 56 - ATP-P 11th Ed

3. Procedural: the acute pain associated with a procedure. This should be anticipated and
a plan for dealing with it should be considered.
SECTION 1 medications (treat pain before considering sedation). However, not every patient requires
Analgesia is the alleviation of pain and should be the primary focus of using these

(or should receive) analgesic medication at first, and unstable patients may require other
therapies or resuscitation before the administration of pain or sedation medications.
Sedation is used to relieve agitation or anxiety and, in some cases, induce amnesia. The
most common causes of agitation are untreated pain or other serious physiologic problems
like hypoxia, hypotension, or hypoglycemia. Sedation is used most commonly to ensure
patient safety (e.g., when agitation is not controlled by analgesia and there is need for the
patient to remain calm to avoid movement that might cause unintentional tube, line, dress-
ing, splint, or other device removal or to allow a procedure to be performed) or to obtain
patient amnesia to an event (e.g., forming no memory of a painful procedure or during
paralysis for ventilator management).
In a Role 1 (or PCC) setting, intravenous (IV) or interosseous (IO) medication delivery
is preferred over intramuscular (IM) therapies. The IV/IO route is more predictable in
terms of dose-response relationship.
Each patient responds differently to medications, particularly with respect to dose.
Some individuals require substantially more opioid, benzodiazepine, or ketamine; some
require significantly less. Once you have a “feel” for how much medication a patient re-
quires, you can be more comfortable giving it to patient with a broad range of injuries.
Similar amounts during redosing. In general, a single medication will achieve its desired
effect if enough is given; however, the higher the dose, the more likely the side-effects.
Additionally, ketamine, opioids, and benzodiazepines given together have a synergistic
effect: the effect of medications given together is much greater than a single medication
given alone (i.e., the effect is multiplied, not added, so go with less than what you might
normally use if each were given alone).
Pain medications should be given when feasible after injury or as soon as possible af-
ter the management of MARCH and appropriately documented (medication administered,
dose, route, and time). Factors for delayed pain management (other than Combat Pill Pack)
are need for individual to maintain a weapon/security and inability to disarm the patient.
PCC requires a different treatment approach than TCCC. Go slowly, use lower doses of
medication, titrate to effect, and re-dose more frequently. This will provide more consistent
pain control and sedation. High doses may result in dramatic swings between over sedation
with respiratory suppression and hypotension alternating with agitation and emergence
phenomenon.

46 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 47