Cgabryszek at 20:06, 6 November 2025

2025-11-06T20:06:29Z

← Older revision		Revision as of 15:06, 6 November 2025
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	'''Protocol:'''		'''Protocol:'''
	~~{\| class="wikitable"~~
	\|'''~~Intermediate~~ -''' ''~~Perform~~/~~Confirm All Above Interventions~~''		'''''EMT - Emergency Medical Technician'''''
	\|}
			# Obtain vital signs and allergies
			# Ask patient to rate pain
			# If the patient indicates mild to moderate extremity pain and has no evidence of open fracture, obvious dislocation, or obvious deformity administer acetaminophen 500 mg orally.

			'''INTERMEDIATE -''' ''PERFORM/CONFIRM ALL ABOVE INTERVENTIONS''

	# Obtain vital signs and allergies		# Obtain vital signs and allergies
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	# Establish an IV of NS TKO		# Establish an IV of NS TKO
	# If patient indicates a pain scale of greater than 5 and has no signs of poor perfusion or respiratory depression:		# If patient indicates a pain scale of greater than 5 and has no signs of poor perfusion or respiratory depression:
	## For patients 6-75 years old: Administer '''fentanyl (Sublimaze)''' 0.5-1 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV~~/IO~~. Reassess patient vital signs and pain scale after 5 minutes.		## For patients 6-75 years old: Administer '''fentanyl (Sublimaze)''' 0.5-1 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV. Reassess patient vital signs and pain scale after 5 minutes.
	## For patients > 75 years old: Administer '''fentanyl (Sublimaze)''' 0.5 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV/IO. Reassess patient vital signs and pain scale after 5 minutes.		## For patients > 75 years old: Administer '''fentanyl (Sublimaze)''' 0.5 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV/IO. Reassess patient vital signs and pain scale after 5 minutes.
	# Reassess pain scale and vital signs including pulse oximetry every 5 minutes		# Reassess pain scale and vital signs including pulse oximetry every 5 minutes
	# If sufficient pain relief is not obtained with the initial dose, then an additional dose of '''fentanyl (Sublimaze)''' 0.5 mcg/kg may be administered IV, IN, IM, or IO provided systolic BP remains above 100 mm Hg for a total max dose of 150 mcg		# If sufficient pain relief is not obtained with the initial dose, then an additional dose of '''fentanyl (Sublimaze)''' 0.5 mcg/kg may be administered IV, IN, IM, or IO provided systolic BP remains above 100 mm Hg for a total max dose of 150 mcg
	# '''Ondansetron (Zofran''') 4 mg IV or IN may be administered for control of patient nausea as needed with or without pain medication. '''~~Consult''' '''Medical Control~~''' for further doses of Zofran if sufficient relief is not obtained.		# '''Ondansetron (Zofran''') 4 mg IV/IO or IN may be administered for control of patient nausea as needed with or without pain medication. c'''ontact ☎ MEDICAL CONTROL ☎''' for further doses of Zofran if sufficient relief is not obtained.

	~~{\| class="wikitable"~~		'''''PARAMEDIC - PERFORM/CONFIRM ALL ABOVE INTERVENTIONS'''''
	\|'''~~Paramedic -~~''' ''~~Perform/Confirm All Above Interventions~~''
	\|}

	# ~~If FENTANYL has been administered and 5 minutes have passed without desired effect, or if there is~~ a ~~contraindication~~ for ~~administration of FENTANYL (signs of poor perfusion or respiratory depression), Contact MEDICAL CONTROL'''''' for consideration of administration of KETAMINE~~.		# For severe pain consider ketamine as a first line drug for pain.
	## ~~If KETAMINE is administered after FENTANYL, the~~ initial recommended dose of KETAMINE is 0.5mg/kg IV~~/IN~~/IO ~~or 2mg~~/~~kg IM~~		## The initial recommended dose of KETAMINE is 0.5mg/kg IV/IO/IN
	## If KETAMINE is administered and there are any signs of emergence phenomena, such as hallucinations, delirium, or increasing agitation, '''~~contact''' '''medical control~~''' for discussion of supplemental Versed.		## If KETAMINE is administered and there are any signs of emergence phenomena, such as hallucinations, delirium, or increasing agitation, c'''ontact ☎ MEDICAL CONTROL ☎''' for discussion of supplemental Versed.
	# Initiate transport and '''~~Contact~~ MEDICAL CONTROL''' for further orders.		# Initiate transport and '''contact ☎ MEDICAL CONTROL ☎''' for further orders.
	# Reassess vital signs, mental status, pain level and respiratory effort and if continued pain over 5, '''~~Contact~~ MEDICAL CONTROL''' for any further dosages.		# Reassess vital signs, mental status, pain level and respiratory effort and if continued pain over 5, '''contact ☎ MEDICAL CONTROL ☎''' for any further dosages.

Cgabryszek: Created page with "'''Purpose:''' To ensure that pain and nausea are appropriately addressed in the field to promote safe and comfortable management and transport of the patient. '''Inclusion Criteria''' without prior Medical Control Authorization: # Musculoskeletal injury # Burns # Chest Pain # Abdominal or flank pain # Age greater than 6 # Systolic BP > 100 mm Hg in an adult # Now known allergies to medications being administered # No known exclusion criteria present '''Inclusion Crit..."

2022-04-03T22:42:03Z

Created page with "'''Purpose:''' To ensure that pain and nausea are appropriately addressed in the field to promote safe and comfortable management and transport of the patient. '''Inclusion Criteria''' without prior Medical Control Authorization: # Musculoskeletal injury # Burns # Chest Pain # Abdominal or flank pain # Age greater than 6 # Systolic BP > 100 mm Hg in an adult # Now known allergies to medications being administered # No known exclusion criteria present '''Inclusion Crit..."

New page

'''Purpose:''' To ensure that pain and nausea are appropriately addressed in the field to promote safe and comfortable management and transport of the patient.

'''Inclusion Criteria''' without prior Medical Control Authorization:

# Musculoskeletal injury
# Burns
# Chest Pain
# Abdominal or flank pain
# Age greater than 6
# Systolic BP > 100 mm Hg in an adult
# Now known allergies to medications being administered
# No known exclusion criteria present

'''Inclusion Criteria''' that require '''Medical Control''' contact prior to medication administration:

# Pregnancy
# Age <6 (may require dosage adjustment)
# Weight <20 kg (may require dosage adjustment)

'''Exclusion Criteria:'''

# Known allergy to medication
# Respiratory distress with potential for patient fatigue
# Systolic BP < 100 mm Hg
# Altered Mental Status
# Multi System Trauma

'''Protocol:'''
{| class="wikitable"
|'''Intermediate -''' ''Perform/Confirm All Above Interventions''
|}

# Obtain vital signs and allergies
# Ask patient to rate pain on scale of 1 to 10
# Establish an IV of NS TKO
# If patient indicates a pain scale of greater than 5 and has no signs of poor perfusion or respiratory depression:
## For patients 6-75 years old: Administer '''fentanyl (Sublimaze)''' 0.5-1 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV/IO. Reassess patient vital signs and pain scale after 5 minutes.
## For patients > 75 years old: Administer '''fentanyl (Sublimaze)''' 0.5 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV/IO. Reassess patient vital signs and pain scale after 5 minutes.
# Reassess pain scale and vital signs including pulse oximetry every 5 minutes
# If sufficient pain relief is not obtained with the initial dose, then an additional dose of '''fentanyl (Sublimaze)''' 0.5 mcg/kg may be administered IV, IN, IM, or IO provided systolic BP remains above 100 mm Hg for a total max dose of 150 mcg
# '''Ondansetron (Zofran''') 4 mg IV or IN may be administered for control of patient nausea as needed with or without pain medication. '''Consult''' '''Medical Control''' for further doses of Zofran if sufficient relief is not obtained.

{| class="wikitable"
|'''Paramedic -''' ''Perform/Confirm All Above Interventions''
|}

# If FENTANYL has been administered and 5 minutes have passed without desired effect, or if there is a contraindication for administration of FENTANYL (signs of poor perfusion or respiratory depression), Contact MEDICAL CONTROL'''''' for consideration of administration of KETAMINE.
## If KETAMINE is administered after FENTANYL, the initial recommended dose of KETAMINE is 0.5mg/kg IV/IN/IO or 2mg/kg IM
## If KETAMINE is administered and there are any signs of emergence phenomena, such as hallucinations, delirium, or increasing agitation, '''contact''' '''medical control''' for discussion of supplemental Versed.
# Initiate transport and '''Contact MEDICAL CONTROL''' for further orders.
# Reassess vital signs, mental status, pain level and respiratory effort and if continued pain over 5, '''Contact MEDICAL CONTROL''' for any further dosages.

2-20 PAIN MANAGEMENT - Revision history

Cgabryszek at 20:06, 6 November 2025