Page 163 - PJ MED OPS Handbook 8th Ed

• Treatment of overdose: Narcan for respiratory depression, ventilatory support, IV/IO access
and fluids for hypotension
Contraindications: known allergy to hydromorphone or other opioid, pregnancy
• Side-effects: respiratory depression or arrest, altered mental status, suppression of gag re-
flex, and hypotension

Ibuprofen (Motrin )
®
• Description: NSAID, analgesic, antipyretic. COX-1 inhibitor
• Indications: mild to moderate pain, fever, acute mountain sickness treatment and preven-
tion, pain reduction during frost bite rewarming
• Dose: 200–800mg PO tid or qid WF. Not to exceed 2400mg/day (800mg tid)

Contraindications: aspirin allergy, history of severe asthma, history of bleeding, not to be
used chronically in combat zone due to risk of worsening bleeding, ACTIVE COMBATANTS/
OPERATORS, pregnancy
• Side-effects: gastric upset
• Adverse reactions: prolonged bleeding time, tinnitus, edema, peptic ulcer, gastritis

Ketamine (Ketalar )
®
GROUNDING medication for personnel on flight status
• Description: rapid-acting general sedative and analgesic
• Indications: severe pain primarily due to trauma, sedation for procedures, and combat agitation
• Adult Dose:
○ Acute Pain
n 25mg IV/IO – slow push over 1min, may repeat q15min until pain is controlled or nys-
tagmus occurs
n 50mg IM/IN – may repeat q30min until pain control or nystagmus. It is preferred to
establish vascular access if able and provide repeat doses IV/IO (20mg)
○ Sedation (dissociation)
○ Bolus:
n Ketamine 150mg IV/IO slow IV push (1–2mg/kg) – repeat as needed to maintain dis-
sociation (q15–30min)
n Ketamine 300mg IM (2–3mg/kg) – repeat q30min PRN
○ Continuous Sedation (1–2mg/kg/hr)
n 1,000mg/250mL NS (4mg/mL) infused at 25–50mL/hr – titrated to adequate response
n Drip concentrations can be varied to meet overall fluid requirement
Contraindications: hypersensitivity

NOTE: It is acceptable to use ketamine for pain in casualties who have had head or eye trauma.

• Adverse Effects:
○ Apnea – support breathing; typically transient and not clinically significant
○ Incomplete dissociation – administer additional ketamine (50% of previous dose)
○ Emergence reaction – administer midazolam (Versed) 1–2mg IV/IO/IN
○ Nausea/vomiting – ondansetron 4mg ODT/IV/IM – repeat q4hr PRN

Chapter 9. Pararescue Drug Formulary n 161