Page 57 - ATP-P 11th Ed

Drips and Infusions
For IV/IO drip medications: Use normal saline to mix medication drips when possible, but
other crystalloids (e.g., lactated Ringer’s, Plasmalyte, and so forth) may be used if normal
saline is not available. DO NOT mix more than one medication in the same bag of crys- SECTION 1
talloid. Mixing medications together, even for a relatively short time, may cause changes
to the chemical structure of one or both medications and could lead to toxic compounds.
If a continuous drip is selected, use only a ketamine drip in most situations, aug-
mented by push doses of opioid and/or midazolam if needed. Multiple drips are difficult
to manage and should only be undertaken with assistance from a Teleconsultation with
critical care experience. Multiple drips are most likely to be helpful in patients who remain
difficult to sedate with ketamine drip alone and can “smooth out” the sedation (e.g., fewer
peaks and troughs of sedation with corresponding deep sedation mixed with periods of
acute agitation).
Other medications that should be available when providing narcotic pain control is
Naloxone. If the patient receives too much medication, consider dilution of 0.4mg of nal-
oxone in 9mL saline (40mcg/mL) and administer 40mcg IV/IO PRN to increase respiratory
rate, but still maintaining pain control.
The PCC Pain Management Guideline Tables
These tables are intended to be a quick reference guide but are not standalone: you must
know the information in the rest of the guideline. The tables are arranged according to
anticipated clinical conditions, corresponding goals of care, and the capabilities needed to
provide effective analgesia and sedation according to the minimum standard, a better op-
tion when mission and equipment support (all medics should be trained to this standard),
and the best option that may only be available in the event a medic has had additional train-
ing, experience, and/or available equipment.
Medications in the table are presented as either give or consider:
a. Give: Strongly recommended.
b. Consider: Requires a complete assessment of patient condition, environment, risks,
benefits, equipment, and provider training.
Use these steps when referencing the tables:
Step 1. Identify the clinical condition
a. Standard analgesia is for most patients. The therapies used here are the foundation for
pain management during PCC. Expertise in dosing fentanyl (OTFC or IV) and ketamine
IV or IO is a must. Intramuscular and intranasal dosing of medications isn’t recom-
mended in a PCC setting.

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