Difference between revisions of "Analgesia and Sedation"

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* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered
 
* [[Nitrous_Oxide|NITROUS OXIDE]] self-administered
 
'''COMBATIVE POST RESUSCITATION / [[Head Injuries|HEAD INJURY]]:'''
 
'''COMBATIVE POST RESUSCITATION / [[Head Injuries|HEAD INJURY]]:'''
* [[Ketamine|KETAMINE (KETALAR)]] 2 mg/kg IVP or IN OR 4 mg/kg IM x 1 dose 
 
 
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect
 
* [[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV or IN, titrated to effect
 
Note: Morphine should be considered first for combative head injury and suspected MI.
 
Note: Morphine should be considered first for combative head injury and suspected MI.
 
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV or IN, titrated to effect
 
* [[Versed|MIDAZOLAM (VERSED)]] 2 - 10 mg IV or IN, titrated to effect
 
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP titrated to effect
 
* [[Valium|DIAZEPAM (VALIUM)]] 2 - 20 mg SLOW IVP titrated to effect
 +
* [[Ketamine|KETAMINE (KETALAR)]] 0.5 mg/kg IVP or IN OR 1 mg/kg IM x 1 dose - Remember that Ketamine is not reversible and may mask changes in patient condition.
 
'''[[Cold Emergencies|FROST BITE]]:'''
 
'''[[Cold Emergencies|FROST BITE]]:'''
 
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain
 
* [[Nitrous_Oxide|NITROUS OXIDE]] self administered, as needed for pain

Revision as of 10:33, 14 December 2020

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.