1. Pain management is important. The only barriers to the usage of effective pain management are allergies and unstable vital signs.

2. Ask patient &/or family members about allergies to any medications.

3. 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

4. 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.

1. Option: FENTANYL 1 – 4 mcg/kg IM/IO/IN every 5 – 10 minutes.

2. 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.