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EMR
EMT
AEMT
Paramedic
Extended
Pain Control
Pain Control
Universal Patient Assessment
Determine the cause of pain
Adult IV/IO
If unable to obtain,
use
alternative route
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
Ketamine
0.1-0.2mg/kg
IV/IO/IM/MAD
Maximum single dose 20mg
Position of Comfort
Calm the Patient
Consider
Ketamine
0.4mg/kg
IV/IO/IM
Maximum 40mg
.
Be
prepared
for
side effects
Hallucinations
Nausea
Nystagmus
May
repeat Fentanyl
at original
dose in
10
minutes if justified
Maximum total dose 300mcg
Visceral Pain
Painful Procedures
Orthopedic Pain
Consider
Midazolam
1-2mg
IV/IO/MAD
For side effects and anxiety
May
repeat Ketamine once
at
0.1mg/kg in
10
minutes
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.
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
Throughout pain
control protocol
perform a continuous
reassessment
Cardiac Monitor
Pulse Oximetry
Capnography
If pain is still severe, vitals are stable,
and medication is justified, add
Fentanyl
1mcg/kg