Pain Control

 

History:

 

  • Age
  • Location
  • Duration
  • Severity (1-10 or Wong-Baker faces scale)
  • Past medical history
  • Medications

 

Significant Findings:

 

  • Severity (pain scale)
  • Quality (sharp/dull/etc.)
  • Radiation
  • Relation to movement
  • Respiration
  • Increase with palpation of area

 

Differential:

 

  • Musculoskeletal
  • Head trauma
  • Visceral (abdominal)
  • Cardiac
  • Pleural/respiratory
  • Neurogenic
  • Renal (colic)
  • Severe pain from extremity injuries, burns, hip injuries, sickle cell crisis, etc.

 

 

 

  • Oxygen

 

 

 

  • Initiate IV, INT is not acceptable

 

 

 

  • Complete set of vital signs including SAO2

 

Pain Severity > 6 out of 10

or

Indication for IV / IM medication

 

  • Systolic BP > 90

 

  • No

 

 

 

 

  • Systolic BP > 90

 

  • Yes

 

 

    • Morphine 0.1 mg/kg IV/IM up to 5 mg; may repeat once every 5 mins to a max of 10 mg

 

 

 

 

 

Must reassess patient at least every 5 minutes after sedative medications.

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Recommended Exam: Mental Status, Area of Pain, Neuro
  • Pain severity (0-10) is a vital sign to be recorded pre, and 15 min post, medication delivery, and at disposition.
  • Zofran (Ondansetron) can cause QT widening.
  • Contraindications to narcotic use:
    • hypotension
    • head injury
    • respiratory distress
    • severe COPD.
  • All patients should have drug allergies documented and avoid medications with a history of an allergy or reaction.
  • Assess for significant head trauma or GCS less than 13. If present, withhold pain management.
  • Maximize the use of non-pharmaceutical pain management techniques (e.g., positioning, padding and splinting, reassurance, heat/cold therapy, etc.) whenever possible.
  • All patients receiving prehospital narcotic analgesic or benzodiazepines should have continuous pulse oximetry monitoring, EKG, and non- invasive capnography (if available).
  • All patients who receive IM or IV medications must be observed 15 minutes for drug reaction.
  • Do not administer any PO medications for patients who may need surgical intervention such as open fractures or fracture deformities, headaches, or abdominal pain.
  • Stop Morphine administration if significant adverse effects (severe nausea, vomiting, signs of poor perfusion, respiratory depression) or sedation (decreased mental status) develop.
  • Respiratory depression should be treated with Oxygen and ventilatory support if necessary.
  • Attempt verbal and tactile stimulation to reverse respiratory depression prior to considering Naloxone (Narcan).
  • Administer the smallest possible reversal dose of Naloxone (Narcan) to maintain adequate respirations.

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician