Page 59 - ATP-P 11th Ed

Table 10 Cont.
PCC Role-based Guideline for Pain Management (Analgesia and Sedation)
T T Drug/Interactions/Dose Onset Duration Side-Effects
C C OTFC (Oral SECTION 1
C C Transmucosal 5 mins 20–40 • Respiratory/cardiac/mental
C C Fentanyl Citrate) when given minutes status depression
- - • Moderate to severe pain, by mouth • Nausea/vomiting
C C unable to fight without • Pruritus (itching)
M M hemorrhagic shock or • Constipation
C C respiratory distress
• 800mcg q30min
• Ketamine 30 secs 10–15 mins • Cataleptic-like state
• Moderate to severe pain, IV or IV or 20–30 ( dissociated from the
unable to fight with 1–5 mins mins IM surrounding environment)
hemorrhagic shock or IM • Respiratory depression at
respiratory distress higher doses (>1mg/kg),
• 30mg (or 0.3mg/kg) slow especially with fast
IV or IO push q20min administration IV/IO
• May repeat • Hypersalivation (can be
• Ketamine 50–100mg (or problematic in an austere
0.5–1mg/kg) IM or IN setting)
q20–30min • Increased blood pressure and
• May repeat heart rate.
For Sedation • Nausea/vomiting
• 1–2mg/kg slow IV push
initial dose
• 300 mg IM
(or 2–3mg/kg IM)
initial dose
• May repeat
Ondansetron (Zofran) 30 min – hr 3–6 hour • Drowsiness
• For nausea/vomiting when given • Fatigue
• 1–2 tabs PO/SL q 4–6hr PO or SL, • Anxiety
PRN 5–10 mins
• 4mg IV, may repeat when given
• 1 time in 2 hours if N/V IV
returns
Naloxone (Narcan) 1–2 minutes 30–90 mins • Abrupt withdrawal reaction
• For complete or partial IV or 2– 5 Note: some from opioid depression should
reversal of opioid minutes opioids be anticipated and preparations
depression (respiratory/ IM/IO have longer should be made.
cardiac/mental) duration so • This reaction may include
• 0.4–2mg IV/IM/IO naloxone vomiting, sweating,
• May repeat q2–3min may need to tachycardia, increased blood
(MAX dose 10mg) be repeated pressure, agitation.
(continues)

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