<--back to table of contents
 

Pain Management

Inclusion Criteria: Patients suffering from severe pain or discomfort.

          Basic Level

  1. Assess and support ABCs. Offer comfort and reassurance.

  2. Patient positioning:
    a.    Initiate spinal movement restrictions, if indicated.
    b.    If no spinal injury suspected, place the patient in a position of comfort.
    c.    If evidence of shock, place the patient supine with the feet elevated and monitor airway closely.
    Treat shock according to the Shock guidelines.

  3. Administer oxygen, as needed to maintain a SpO2 of at least 96%.

  4. Splint injured extremities and apply cold packs.

  5. Once advanced level care arrives on scene, give report and transfer care.


    Advanced Level

  6. If the patient can cooperate, have the patient self-administer nitrous oxide (optional medication).

  7. Consider establishing IV access at a TKO rate or use a saline lock.
    a.    If the adult or pediatric patient is experiencing a sickle cell crisis, administer 10 ml/kg normal saline, then maintain TKO rate.

  8. If the patient cannot cooperate with nitrous oxide administration, if its use is contraindicated, or if the pain is unrelieved; administer

    Adult

    • fentanyl 1 mcg/kg via IN or slow IVP.
      o   May repeat every 15 minutes
      o   Do not exceed 200 mcg
    • morphine 2 mg-4 mg increments slow IVP up to a maximum of 20 mg, titrate to effect
    • CONTACT BIOTEL before administeringmorphine or fentanyl if the patient
      o   is older than 65 yr of age, or
      o   debilitated, or
      o   has altered mental status, or
      o   SBP less than 110mmHg

    Pediatric

    • fentanyl 1 mcg/kg via intranasal or slow IVP (Max dose 200 mcg)
    • No standing orders for morphine
    NOTE:  Individual departments may carry none, one, or both of these analgesics. There is no uniform requirement for all departments to carry these medications.


  9. Following analgesia administration, monitor for any respiratory or level of consciousness depression.

  10. For additional patient care considerations not covered under standing orders, consult BioTel.

 

 

<--back to table of contents