Protocol 2-660 - Pain Control

CMH EMS & MIH Protocols

EMD:

• No specific protocol.

EMR:

• Identify possible causes.
• Consider Oxygen if SpO2 is less than 88%.
• Consider applying Cardiac Monitor limb leads.
• Consider BLS pain relief actions:
• Splinting or immobilizing.
• Elevating.
• Cold pack.
• Verbal sedation.

EMT:

• Ensure completion of applicable items above.
• Assume abdominal, back, and/or thoracic pain with unknown cause is a STEMI: Obtain a 12-Lead ECG within 10 minutes of patient contact.
• If narcotic administered: Consider assisting ALS with Capnography.

AEMT:

• Ensure completion of applicable items above.
• Consider IV NS/LR.

RN:

• Ensure completion of all applicable items above.
• Consider IO NS/LR.
• Painful procedure of short duration (i.e., cardioversion, external cardiac pacing, fracture manipulation, extrication, etc.):
• Consider Etomidate 0.1 mg/kg IV/IO.
• Click "calculate" to get dose.
• Consider Ketamine (dissociative dose):
• 1-2 mg/kg IV/IO.
• 4-5 mg/kg IM.
• Over 65 years old: Half dose.
• Click "calculate" to get dose.
• Click "calculate" to get dose.
• Click "calculate" to get dose.
• Click "calculate" to get dose.

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• Severe pain: Give Fentanyl prior to Ketamine
• Severe pain: Consider Ketamine (analgesic dose):
• 0.1-0.5 mg/kg [ideal body weight] IV/IO.
• 0.8-1 mg/kg [ideal body weight] IM.
• Over 65 years old: Half dose.
• Enter weight and height and click "calculate" to get dose based on IDEAL weight.
• Enter weight and height and click "calculate" to get dose based on IDEAL weight.
• Enter weight and height and click "calculate" to get dose based on IDEAL weight.
• Enter weight and height and click "calculate" to get dose based on IDEAL weight.
• Acute or chronic (acute exacerbation with autonomic signs and symptoms) pain:

• Adult:

  Pediatric:

  Consider Fentanyl 12.5-100 mcg IV/IO/IM/IN. May repeat every 15 minutes. Over 65 years old: 12.5-50 mcg. May repeat every 15 minutes (max 150 mcg). Only During Fentanyl Shortage Consider Morphine 2-5 mg IV/IO/IM (max 10 mg). Maintain SBP greater than 100. Consider Benadryl 25-50 mg IV/IO to potentiate Morphine and reduce hypotension. Consider Toradol 15 mg IV/IO or 15 mg IM. Contraindicated in pregnancy. Over 65 years old: 15 mg IV/IO or 15 mg IM.

  Consider Fentanyl 1-2 mcg/kg IV/IO/IN. May repeat every 15 minutes. Click "calculate" to get dose. Only During Fentanyl Shortage use one or the other of the below Morphine dosages. Consider Morphine 0.1mg/kb g IV/IO may repeat 0.1mg/kg in 30 minutes (IM only if IV/IO access unobtainable. Do not repeat IM dosage.) OR Consider Morphine 0.2 mg/kg IV/IO may not repeat (IM only if IV/IO access unobtainable. Do not repeat IM dosage.) Consider Benadryl 25-50 mg IV/IO to potentiate Morphine and reduce hypotension.

• Chronic pain without autonomic signs and symptoms: Transport in position of comfort.
• Any patient receiving narcotics must be transported.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.
• Refer to MIH Protocol - Chronic Pain Management.

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