Page 266 - 2023 SMOG Digital

PAIN MANAGEMENT

Signs and Symptoms:
• Tachycardia
• Diaphoresis
• Elevated Blood Pressure
• Vocalizes and/or Signals Pain
Continued From: Fentanyl
Tactical Evacuation Guideline 0.5-1mcg/kg IV/IO
100mcg IN
m
8
0
0
c
PO 800mcg OTFC
g
Patient care according to guideline
based on specific complaint
Ketamine
Consider: Moderate to Severe Pain (>3/10) 0.5mg/kg IM/IN
Acetaminophen 1g PO prn NO Vocalizes/Signals Pain and 0.1-0.2mg/kg IV/IO
every 6-8 hours max 4g in requests relief
24 hour period OR
Indication for IV/IM medications?
YES
Ensure: Morphine
SpO2 / Monitors Attached MODERATE - SEVERE PAIN MANAGEMENT MEDICATION 0.1mg/kg IV/IO (wt based dosing)
p
2-5mg IV/IO
Administer Pain Medication
Best indicated for Patient Condition
Hydromorphone
0.5 mg IV/IO q1-6hr prn
q
0.25-2mg (wt based dosing)
Ondansetron 4-8mg IV/IM Long acting, effective, risk of hypotension
Monitor and Reassess or respiratory depression if over-medicated
Ketorolac
15mg IV q6hr or 15-30mg IM every
6hr, max daily dose 120mg
Return To: Not for use in trauma patients, or those at
Tactical Evacuation Guideline risk for bleeding or kidney failure
OR (elderly, volume depletion)
Appropriate Guideline per
Complaint if unable to maintain adequate pain
control seek Medical consultation
Pearls:
• Document patient’s medications and all allergies prior to administration of medications.
• PO medications should not be used in any patient with altered mental status or anyone in whom
surgery is anticipated, unless directed by transferring provider.
• Narcotic pain medications can be reversed with Naloxone 0.4-2mg IV.
• Start with low dosage of pain medications and titrate upward to desired effect.
• Fentanyl and Morphine will cause a decrease in BP through various drug effects. Fentanyl is
preferred over Morphine for immediate pain control.
• Treatment of “Ketamine Associated Psychiatric Distress” or “Ketamine induced agitation,”
o Midazolam 2-5mg IV x1 prn for agitation due to Ketamine administration
• Morphine and/or Ketamine auto-injectors may be used if available; however IV/IO route is preferred.
• Ketamine can cause slight decrease in blood pressure, especially with hypotensive shock patients,
lower doses are recommended in this type of patient.
• Fentanyl OTFC 800mcg may be used if patient is conscious. Do NOT CHEW
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