Page 150 - Journal of Special Operations Medicine - Summer 2016

Triple-Option Analgesia Triple-Option Analgesia
Option 1

Tactical Field and TACEVAC Care Tactical Field and TACEVAC Care:
• Analgesia on the battlefield should 1) Mild to Moderate Pain
generally be achieved using one of three Casualty is still able to fight
options depending on the level of the - TCCC Combat pill pack:
casualty’s pain and the nature of his or her - Tylenol - 650-mg bilayer
injuries. caplet, 2 PO
- Meloxicam - 15 mg PO

Triple-Option Analgesia Triple-Option Analgesia
Option 2 Option 3

2) Moderate to Severe Pain 3. Moderate to Severe Pain
Casualty IS NOT in shock or respiratory distress Casualty IS in hemorrhagic shock or respiratory distress
OR
AND Casualty IS at significant risk of developing either condition
Casualty IS NOT at significant risk of developing - Ketamine 50 mg IM or IN
either condition Or
- Oral transmucosal fentanyl - Ketamine 20 mg slow IV or IO
citrate (OTFC) 800 ug
- Place lozenge between the * Repeat doses q30min prn for IM or IN
cheek and the gum * Repeat doses q20min prn for IV or IO
* End points: Control of pain or development of
- Do not chew the lozenge nystagmus (rhythmic back-and-forth movement of the eyes)

Warning: Morphine and Ketamine - Safety
Fentanyl Contraindications

• Very favorable safety profile
• Hypovolemic shock • Few, if any, deaths attributed to ketamine as
• Respiratory distress a single agent
• Unconsciousness • FDA Insert:
• Severe head injury – "Ketamine has a wide margin of safety; several
instances of unintentional administration of
• DO NOT give morphine or fentanyl to overdoses of ketamine (up to ten times that
casualties with these contraindications. usually required) have been followed by
prolonged but complete recovery.”

136 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016