Pain management is important. The only barriers to the usage of effective pain management are allergies and unstable vital signs.
Ask patient &/or family members about allergies to any medications.
Requirements for pain medication usage:
a. No allergies to pain medications
b. Systolic blood pressure (SBP) > 90 mm Hg
c. Continuous cardiac monitoring
d. IV access
Pain control:
a. FENTANYL 50 - 100 mcg IV every 5 - 10 minutes as needed for effective pain control. Contact Medical Control if repeated doses required.
Option: FENTANYL 1 – 4 mcg/kg IM/IO/IN every 5 – 10 minutes.
Option: MORPHINE 2 – 5 mg IV every 5 – 10 minutes.
b. If level of consciousness decreases OR RR < 10 OR SBP < 80, cease administration of fentanyl and administer NALOXONE (Narcan) 2 mg IV. If this is successful, you may repeat as needed enroute.
c. If SEVERE pain not adequately controlled with narcotics, you may consider KETAMINE 0.5 – 1 mg/kg IV. Re-bolus as needed during extrication.