Inclusion Criteria: Patients suffering from severe pain or discomfort.
SPECIAL NOTE: Withholding analgesia from a patient in pain is considered negligence.
- Assess and support ABCs. Offer comfort and reassurance.
- Patient positioning:
- Initiate SPINAL MOTION RESTRICTION, if indicated.
- If no spinal injury is suspected, place the patient in a position of comfort.
- If there is evidence of shock, place the patient supine with the feet elevated and closely monitor airway status. Treat shock according to the SHOCK Guidelines.
- Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
- Assess and document neurovascular status and perfusion of injured extremities. Splint injured extremities and apply cold packs. SPECIAL NOTE: Do NOT use a traction splint for patients under 14 years of age.
- Once advanced level care arrives on scene, give report and transfer care.
- Consider establishing IV/IO access at a TKO rate or use a saline lock.
- For an adult or pediatric patient with sickle cell crisis, administer 10 mL/kg Normal Saline, then maintain TKO rate.
- Once drug allergies have been verified, administer pain medication according to the following:
- Fentanyl 1 mcg/kg slow IVP/IO, IM, or IN.
- May repeat every 15 minutes.
- Do not exceed 200 mcg total, cumulative dose.
- Morphine 2 mg – 4 mg increments slow IVP or IO or IM, up to a total maximum, cumulative dose of 8 mg. Titrate to effect.
- Contact BioTel before administering morphine or fentanyl if the patient:
- Is older than 65 years of age; or
- Is debilitated; or
- Has altered mental status; or
- Has a SBP less than 90 mmHg.
- Fentanyl 1 mcg/kg via slow IVP/IO, IM or IN;
- Maximum single dose 100 mcg.
- May repeat once after 15 minutes, if needed; OR
- Morphine 0.05 mg/kg slow IVP/IO or IM;
- Maximum single dose 2 mg.
- May repeat once after 15 minutes, if needed.
- Monitor for cardiorespiratory depression.
- Contact BioTel for authorization if the patient requires additional analgesic doses.
NOTE: Individual agencies may carry none, one, or both of these analgesics. There is no uniform requirement for all agencies to carry these medications.
- After analgesia administration, monitor for cardiorespiratory depression or excessive sedation.
- For additional patient care considerations not covered under standing orders, consult BioTel