2015 Trumbull Memorial Hospital Demo

Pain Control Pain Control

Information to Record  Time of arrival  HR, RR, BP, GCS  Time of each dose  Dose Given  Time and results of pain score/quality  Cause and location of pain

> 16 years old

Universal Patient Assessment

Adult IV/IO If unable to obtain, use alternative route

Position of Comfort Calm the Patient

Determine the cause of pain

Painful Procedures

Visceral Pain

Orthopedic Pain

Fentanyl 1 mcg/kg via IV/IO/IM/MAD (0.5mcg/kg for frail elderly) Maximum single dose 100mcg Consider Fentanyl 3 mcg/kg IV/IO/IM For patients with a tolerance to opioids

Consider Ketamine 0.4mg/kg IV/IO/IM Maximum 40mg . Be prepared for side effects  Hallucinations  Nausea  Nystagmus Throughout pain control protocol perform a continuous reassessment  Cardiac Monitor  Pulse Oximetry  Capnography

Consider Midazolam 1-2mg IV/IO/MAD For side effects and anxiety

Ketamine 0.1-0.2mg/kg IV/IO/IM/MAD Maximum single dose 20mg

May repeat Fentanyl at original dose in 10 minutes if justified Maximum total dose 300mcg

May repeat Ketamine once at 0.1mg/kg in 10 minutes

If pain is still severe, vitals are stable, and medication is justified, add Fentanyl 1mcg/kg

Pain Management Considerations  Ketamine is better than Fentanyl for orthopedic pain. Fentanyl is better than Ketamine for visceral pain.  Consider giving 1-2mg of Midazolam with your Ketamine dose to produce somnolence and reduce hallucinations, if the blood pressure is adequate.  Consider Zofran for nausea before or after Fentanyl or Ketamine.  Fentanyl and Ketamine potentiate one another, increasing effectiveness.  Remember to dilute ketamine for the IV/IO route  When properly diluted , the ketamine syringe contains 5 mg/mL , and 4 mL is the maximum single dose  Ketamine IM/IN should not be diluted, and may be less effective via those routes.  Ketamine is contraindicated in schizophrenia.

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EMR

EMT

AEMT

Paramedic

Extended