Analgesia and Sedation

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Section 2 - PRIMARY CARE

2.04 ANALGESIA/SEDATION

"THE BELOW MEDICATIONS MAY ALL CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A MUST! ALLOW AMPLE TIME FOR EACH DOSE TO TAKE EFFECT PRIOR TO ANY ADDITIONAL DOSES BEING ADMINISTERED."

PAIN MANAGEMENT: Moderate to severe pain is an “Emergency Medical Condition”, which historically has been undertreated in EMS. Moderate to severe pain can be described as pain greater than or equal to 6 on the 0-10 pain scale. Pain management should target the two components of pain: physiologic pain, pain receptors and psychologic, anxiety, fear, etc. The treatment of pain and anxiety can be accomplished with narcotic analgesics and benzodiazepines in a safe and reversible manner. The maximal effects of a IV or IO dose of a analgesic or anxiolytic occurs within seconds, not minutes.

Considering the above, a logical approach to pain management in an average-sized adult would be to titrate IV Morphine up to 10 mg then titrate Valium or Versed up to 10 mg. Complications can be reversed by administering Narcan or Romazicon.


PROCEDURE:

  • The numeric rating scale will be used to measure pain on all patients. The numeric rating scale ranges from 0 (no pain) to 10 (unbearable pain).
  • Non-pharmaceutical (BLS) interventions such as: immobilization of fractures; elevation of extremities; ice packs and padding of spine boards and splints should be attempted first, then re-assess the patient.
  • If the pain is still significant (6 or greater) and the patient does not have a contraindication then follow the guidelines below.
  • Vital signs are to be taken before and after the administration of the medication. Appropriate documentation is expected.
  • Patient's will be continuously monitored while they are under the influence of one of these medications. This will include at a minimum vital signs every 5 minutes and pulse oximetry.

ANGINA / MYOCARDIAL INFARCTION:

ACUTE ABDOMINAL PAIN:

ANXIETY:

BURNS: (with moderate to severe pain)

COMBATIVE POST RESUSCITATION / HEAD INJURY:

Note: Morphine should be considered first for combative head injury and suspected MI.

FROST BITE:

MUSCULOSKELETAL PAIN / EXTREMITY PAIN:

FLANK PAIN/SUSPECTED KIDNEY STONES:

  • TORADOL (KETOROLAC) 15mg – 30mg IV depending on hydration status
  • MORPHINE SULFATE 2-20mg IV, IO or IN titrated to effect

SICKLE CELL ANEMIA CRISIS:

PEDIATRIC PATIENTS:

PROCEDURAL SEDATION: Cardioversion, Pacing, Intubation

THE ABOVE MEDICATIONS MAY ALL CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A MUST! ALLOW AMPLE TIME FOR EACH DOSE TO TAKE EFFECT PRIOR TO ANY ADDITIONAL DOSES BEING ADMINISTERED.

  • These drugs may be given in combination for maximum effectiveness.
  • Ensure that Pulse Oximeter is in place.
  • Ensure that BVM, FLUMAZENIL (ROMAZICON) and/or NALOXONE (NARCAN) are readily available.