Page 58 - ATP-P 11th Ed

b. Difficult analgesia or sedation needed is for patients in whom standard analgesia does
not achieve adequate pain control without suppressing respiratory drive or causing hy-
SECTION 1 c. Protected airway with mechanical ventilation is for patients who have a protected air-
potension, OR when mission requirements necessitate sedating a patient to gain control
over their actions to achieve patient safety, quietness, or necessary positioning.
way and are receiving mechanical ventilatory support or are receiving full respiratory
support via assisted ventilation (i.e., bag valve).
d. Shock present is for patients who have hypotension, active hemorrhage, and/or
tachycardia.
Step 2. Read down the column to the row representing your available resources and
training.
Step 3. Provide analgesia/sedation medication accordingly.
Step 4. Consider using the Richmond Agitation-Sedation Scale (RASS) score (Appendix E)
as a method to trend the patient’s sedation level.

Table 10 PCC Role-based Guideline for Pain Management (Analgesia and Sedation)
PCC Role-based Guideline for Pain Management (Analgesia and Sedation)
T T T T Complete Basic TCCC Communication Plan for Pain Management then:
C C C C • Administer meloxicam and acetaminophen (pain medications in Joint First Aid Kit
C C C C [JFAK]) per TCCC guidelines if not already given.
C C C C • Identify painful conditions that can be treated without the use of medications.
- - - - » Fractures: apply splint per TCCC guidelines.
A C C C » Exposed burns: burn care per TCCC guidelines.
S L M P » Tourniquets will cause significant pain – DO NOT remove a tourniquet in an attempt to
M S C P alleviate pain unless directed to do so by a higher medical authority.
Drug/Interactions/Dose Onset Duration Side-Effects
Acetaminophen <1 hr when 4–6 hours • Allergic Reaction (rare)
• Mild-moderate pain, given by • Liver damage: limit daily
able to fight mouth dose of acetaminophen and
• Use with meloxicam acetaminophen-containing
• 1g q6hr products (e.g., Percocet) to
4,000mg/day
Meloxicam <1 hr when 24 hours • Reflux
• Mild-moderate pain, given by • Abdominal pain
able to fight mouth • Nausea/vomiting
• Use with acetaminophen • Diarrhea and/or constipation
• 15mg daily
Administer meloxicam and acetaminophen (in JFAK) per TCCC guidelines if not already
given.
• Pain medications should be given when feasible after injury or as soon as possible after the
management of MARCH and appropriately documented (medication administered, dose,
route, and time).
• Pain meds initiated in TCCC can often be continued in the PCC environment for both on-
going analgesia and sedation, as long as the duration and cumulative side effects are well
understood and mitigated.
(continues)

48 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 49