- Severity (1-10 or Wong-Baker faces scale)
- Past medical history
- Drug allergies
- Severity (pain scale)
- Quality (sharp/dull/etc.)
- Relation to movement
- Increase with palpation of area
- Head trauma
- Visceral (abdominal)
- Renal (colic)
- Initiate IV, INT is not acceptable
- Complete set of vital signs including SAO2
- Consider Nitrous Oxide
- Consider Toradol 15 mg IV, or 30 mg slow IM; single dose
- Ketamine 0.3 mg/kg IV/IO; 30 mg max single dose; may repeat once after 15 minutes
- Morphine 0.1 mg/kg IV/IM up to 5 mg; may repeat once every 5 mins to a max of 10 mg
- Fentanyl 2 mcg/kg slow IV/IO/IM can repeat once in 5 minutes. Max single dose of 100 mcg, Max total dose 200 mcg.
- Must reassess patient at least every 5 minutes after sedative medications.
- Pain severity (0-10) is a vital sign to be recorded pre, and post IV or IM medication delivery, and at disposition.
- Vital signs whouls be obtained per, 5 minutes post, and at disposition with all pain medications.
- Zofran (Ondansetron) can cause QT widening.
Contraindications to narcotic use:
- head injury
- respiratory distress
- severe COPD.
- All patients should have drug allergies documented and avoid medications with a history of an allergy or reaction.
- Contraindications to Toradol include active bleed (including ulcer and GI) current anticoagulation therapy, pregnant or CVA\TBI < 24 hours, possible surgery.
- 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.
- 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.