Inclusion Criteria: Patients suffering from severe pain or discomfort.
- Assess and support ABCs. Offer comfort and reassurance.
- 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.
- Administer oxygen, as needed to maintain a SpO2 of at least 96%.
- Splint injured extremities and apply cold packs.
- Once advanced level care arrives on scene, give report and transfer care.
- If the patient can cooperate, have the patient self-administer nitrous oxide (optional medication).
- 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.
- If the patient cannot cooperate with nitrous oxide administration, if its use is contraindicated, or if
the pain is unrelieved; administer
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
|NOTE: Individual departments may carry none, one, or both of these analgesics. There is no
uniform requirement for all departments to carry these medications.
- Following analgesia administration, monitor for any respiratory or level of consciousness depression.
- For additional patient care considerations not covered under standing orders, consult BioTel.