PAIN CONTROL PROTOCOL

General Considerations

  • This protocol is for management of acute moderate to severe pain, including pain from suspected cardiac events, trauma, including thermal and chemical burns, crush syndrome, frostbite, fractures, dislocations, sprains, and abdominal pain including unilateral flank pain.

  • It is not for treatment of exacerbations of chronic pain.

  • ♦ Call for orders if you feel narcotics are needed for pain from a chronic condition.

  • Prehospital pain management is important. It significantly reduces time to pain relief, avoids exacerbation of pain during movement and transport, is compassionate, and is good medical care.

  •  Document patient’s reported pain during initial patient contact, during treatment, and after any intervention.

  •  Use cold packs, position of comfort, and splinting to reduce pain as indicated.

  • Always consider the weight of your patient when dosing pain meds, especially in the elderly population.

Specific Care

  • For moderate to severe pain relief when the patient is alert:

    •  Consider Fentanyl 50-100 mcg slow IV, provided SBP > 100.

    •  If no response, or inadequate response to IV Fentanyl, and a second drug bag is available,

      • May repeat slow IV Fentanyl 50-100 mcg, after 15 minutes provided SBP > 100.

  • If unable to obtain IV:

    •  Give Fentanyl 50-100 mcg IN or IM.

      •  Repeat dose of Fentanyl 50-100 mcg IN or IM, no sooner than 15 minutes, if second drug bag is available.
  • P  ♦ MCP CONTACT REQUIRED BEFORE ADMINISTRATION OF FENTANYL FOR PEDIATRIC PATIENTS WITH ABDOMINAL PAIN.
  • P FENTANYL IS NOT TO BE ADMINISTERED TO ANYONE < 2 YEARS OF AGE.
  • P For severe pain relief when the patient is conscious and alert the first choice is:
    •  Fentanyl 1 mcg/kg IN, max dose 100 mcg.
    • May repeat Fentanyl 1 mcg/kg IN after 15 minutes, if an additional drug bag is available.
    • Consider Fentanyl 1 mcg/kg, slow IV, max dose 100 mcg, provided appropriate normal SBP (80 + 2x age in years).
    • May repeat Fentanyl 1 mcg/kg, slow IV after 15 minutes, max dose 100 mcg, if still in pain, appropriate SBP and a second drug bag is available.
  • P  If unable to obtain IV: IM FOR PEDS IS A LAST RESORT.
    •  Give Fentanyl 1 mcg/kg IM, max dose 100 mcg
    •  Repeat dose of Fentanyl 1 mcg/kg IM, max dose 100 mcg, repeat no sooner than 15 minutes if a second drug bag is available.
 

Quick Dial