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30.01 PAIN MANAGEMENT

All Providers

  • Universal Patient Assessment Protocol
  • Treatment Plan
    • Assess pain using verbal and non-verbal cues, 0-10 scale, Wong-Baker faces scale
    • Consider non-pharmacologic measures
    • Immobilize any obvious injuries and place patient in position of comfort
    • Implement pharmacologic measures
      • VS every 5 minutes
      • Have naloxone available
      • Avoid or stop medication for SBP < 90 mmHg in adults
      • Avoid or stop medication for SBP < 70 + (age in years x 2) in pediatric patients
      • Stop medication dosing when the patient has adequate relief, pain score < 5
    • Monitor respiratory rate, oxygen saturation
Key Considerations
  • Use Wong-Baker Faces for patients 3-8 years of age
  • FLACC scale can be used to assess pain in infants

Adult

EMT
  • Consider Zofran 4 mg oral/SL for nausea prophylaxis or treatment
AEMT
  • IV/IO Access and Fluid Therapy Protocol
  • Fentanyl 50-100 mcg IV, IO, or IN every 30 minutes as needed for pain >6/10
  • Consider Zofran 4 mg IV/IO/IM/oral for nausea prophylaxis or treatment
Paramedic
  • Fentanyl 25-100 mcg IV, IO or IN every 10 minutes as needed
  • Midazolam IV/IO/IN – 5 mg may repeat once in 10 minutes IM – 10 mg once
  • Rapid Sequence Intubation consider Fentanyl 25-100 mcg IV/IO prior to sedation
Contact OLMC for doseages above those provided

Pediatric
not to exceed adult dose

EMT
AEMT
Contact OLMC and approve use of parenteral narcotic
  • Fentanyl 1mcg/kg IV/IO/IN every 30 minutes as needed for severe pain
  • Consider Zofran 4 mg IV/IO/IM/oral for nausea prophylaxis or treatment in children > 40 kg
  • Consider Zofran 0.1 mg/kg IV/IO/IM for children < 40 kg, maximum single dose of 4 mg
Paramedic
  • Fentanyl 1 mcg/kg (max 50 mcg/dose) IV/IM/IO or IN every 10 minutes as needed
    • Use 2 mcg/kg for IN (max of 100 mcg/dose)
  • Midazolam
    • IV/IO – 0.1 mg/kg (max 5 mg), may repeat times one in 10 minutes
    • IN – 0.3 mg/kg (max 5 mg), may repeat times one in 10 minutes
    • IM – 0.15 mg/kg (max 5 mg) once
  • Rapid Sequence Intubation
    • Fentanyl 1 mcg/kg (max 50 mcg/dose) IV/IM/IO prior to sedation
    • Atropine 0.02 mg/kg IV/IO after sedation
Contact OLMC for doseages above those provided