Page 62 - ATP-P 11th Ed

Table 10 Cont.
PCC Role-based Guideline for Pain Management (Analgesia and Sedation)
SECTION 1 T Tramadol (Ultram) 10–20 4–6 hours • Drowsiness
Drug/Interactions/Dose
Duration
Side-Effects
Onset
C
C
• For moderate-severe
minutes
• Respiratory depression
C
pain
- • 1–2 tabs PO q4–6hr • Sedation
C PRN (DO NOT exceed • Nausea/vomiting
M 400mg tramadol/day) • CNS stimulation including
C seizures at high doses
Note: Some preparations (i.e.,
Ultram) contain acetaminophen.
Be aware of total dose when
given with other drugs that
contain acetaminophen.
Codeine/acetaminophen 30 minutes– 4–6 hours • Drowsiness
• For moderate-severe 1 hour • Respiratory depression
pain • Sedation
• 1–2 tabs PO q4–6hr • Nausea/vomiting
PRN (for tabs with • Itching
15mg Codeine) Note: Contains acetaminophen.
Be aware of total dose when
given with other drugs that
contain acetaminophen.
• In some cases, local anesthetics or even limited regional anesthesia is the best option for pain
control (For more information, see Military Analgesia Regional Anesthesia Guidelines.)
• While side effects are real and toxic levels of these drugs must be understood and avoided,
the benefit can often be achieved without sedation when appropriate for the tactical
environment.
Special Considerations
Patient Monitoring During Sedation
Patients receiving analgesia and sedation require close monitoring for life-threatening side-
effects of medications.
a. Minimum: Blood pressure cuff, stethoscope, pulse oximeter; document vital signs
trends.
b. Better: Capnography in addition to minimum requirements
c. Best: Portable monitor providing continuous vital signs display and capnography; docu-
ment vital signs trends frequently.
Analgesia and Sedation for Expectant Care (i.e., End-of-Life Care)
An unfortunate reality of our profession, both military and medical, is that we encounter
clinical scenarios that will inevitably end in a patient’s death. In these situations, it is a

52 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 53