Protocol 2-660 - Pain Control

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.

Medic:

Ensure completion of all applicable BLS items above.

Consider IO NS/LR.

Painful procedure of short duration (i.e., cardioversion or extrication):

Cardioversion: Consider Etomidate 0.1 mg/kg IV/IO.

Click "calculate" to get dose.

Consider contacting MEDICAL CONTROL for 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.

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 5 minutes. Over 65 years old: 12.5-50 mcg. May repeat every 5 minutes (max 150 mcg). 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 30 mg IV/IO or 60 mg IM. Contraindicated in pregnancy. Over 65 years old: 15 mg IV/IO or 30 mg IM.	Consider Fentanyl 1-2 mcg/kg IV/IO/IN. May repeat every 5 minutes. Click "calculate" to get dose. Consider Morphine 0.1-0.2 mg/kg IV/IO/IM. May repeat every 5 minutes. Click "calculate" to get dose. Consider Benadryl 1 mg/kg (max 50 mg) IV/IO to potentiate Morphine and reduce hypotension. Click "calculate" to get dose.

Adult:

Pediatric:

Consider Fentanyl 12.5-100 mcg IV/IO/IM/IN. May repeat every 5 minutes.

Over 65 years old: 12.5-50 mcg. May repeat every 5 minutes (max 150 mcg).

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 30 mg IV/IO or 60 mg IM.

Contraindicated in pregnancy.
Over 65 years old: 15 mg IV/IO or 30 mg IM.

Consider Fentanyl 1-2 mcg/kg IV/IO/IN. May repeat every 5 minutes.

Click "calculate" to get dose.

Consider Morphine 0.1-0.2 mg/kg IV/IO/IM. May repeat every 5 minutes.

Click "calculate" to get dose.

Consider Benadryl 1 mg/kg (max 50 mg) IV/IO to potentiate Morphine and reduce hypotension.

Click "calculate" to get dose.

Chronic pain without autonomic signs and symptoms: Transport in position of comfort.

Any patient receiving narcotics must be transported.

NEMSIS Protocol: 9914071 - General-Pain Control

Citations:

Protocol 9-010 - References
Boland, Satterlee, & Jansen, 2014
Cox Paramedics, 2014
Finn, et al., 2004
NASEMSO Medical Directors Council, 2017
Taney County Ambulance District, 2014

Change Log:

Date	Link to previous version	Description of change
02/22/14	pdf	Added medical control for Ketamine.
12/12/14		Added weight-based dosage for greater than 65 yr for Fentanyl. Added IM option for Morphine. Added option for Toradol.
12/15/14		Added Dilaudid medication.
05/05/15	pdf	Modified Ketamine for chemical extrication (4 mg/kg IM and removed medical control).
08/06/15		Added IM route for Fentanyl. Added IM route for Morphine. Added analgesic and disassociative doses of Ketamine. Added comment to half the dose of Ketamine if age over 65 yr.
11/17/15		Modified over 65 yr old Fentanyl dose to 25-50 mcg with a max of 150 mcg.
04/06/16	pdf	Added the need for medical control to administer the dissasociative dose of Ketamine. This was at specific request of CMH medical director.
06/29/16		Added consider Benadryl with all Morphine administrations.
08/24/17	pdf	Removed Ativan and Dilaudid. Added BLS pain control measures.
09/22/17		Reduced all dosages for Toradol by 50% to align with NASEMSO. Increased Ketamine analgesic dose from 0.2 to 0.5. Removed hot pack under BLS pain control. Modified pediatric Versed dosages.
11/14/17	pdf	Changed minimum initial dosage of Fentanyl to 25 mcg to allow more flexibility.
08/24/18	pdf	Added comment to consider capnography if narcotic used. Added option for Etomidate for procedural sedation of cardioversion. Removed maximum Fentanyl dose. Changed minimum adult Fentanyl dose from 25 to 12.5 mcg.
04/18/20	pdf	Added content (without substantive modification) from old Protocol 6-050 - Control of Pain.
02/19/21	pdf	Corrected typo where Toradol can be administered both IM and IV to over 65 yr olds.
06/06/21	pdf	Moved to emsprotocols.online
11/05/21	pdf	Added requirement for analgesic dose of Ketamine to be dosed from IDEAL body weight. This is a result of multiple requests from Dr. Nicholes even after a request to keep actual dose from protocol committee. Final confirmation from Dr. Nicholes on 6/8/21. Calculators updated to only give dose after patient height has been entered to accurately calculate IDEAL weight like the RSI protocol does for paralytics.
12/01/21		Fixed an error with a link to Fentanyl.
02/28/22		Updated link to Toradol.

CMH PHS Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

Protocol 2-660 - Pain Control

EMD:

EMR:

EMT:

AEMT:

RN

Medic:

Citations:

Change Log: