Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

Pain Management (Adult)

 

History:

 

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

 

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)

 

Treatment:

 

  • Oxygen
  • 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

 

OR

 

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

 

OR

  • 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.

 

PEARLS:

 

  • 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:
    • 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.
  • 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.