Pain Management

ADULT ANALGESIA

Indications: Mild to moderate pain may receive acetaminophen/ibuprophen or mild to severe pain may receive ketorolac for an isolated hip or extremity trauma or burns or  renal colic (with a prior history) or  acute musculoskeletal back strain or current history of cancer related pain.

Acetaminophen: If the patient is 18 years of age or older and does not have an altered LOA, has not used acetaminophen in the last 4 hours, does not have an allergy or sensitivity to acetaminophen, does not have a history of liver disease, is not actively vomiting and is able to take oral medications administer 960-1000mg acetaminophen PO (to a maximum dose of 1000mg).  The maximum number of doses is 1.

Ibuprophen:  If the patient is 18 years of age or older and deos not have have an unaltered LOA, has not used NSAID or ibuprophen use within the previous 6 hours, does not have an allergy or sensitivity to ASA or NSAIDS, are not on anticoagulation therapy, do not have active bleeding, doe not have a history of peptic ulcer disease or GI bleed, are not pregnant, have not had a CVA or TBI in the previous 24 hours, do not have known renal impairment, and are able to take oral medications then administer 400mg ibuprophen PO (to a maximum dose of 1000mg).  The maximum number of doses is 1.

Ketorolac: If the patient is 18 years of age or greater and does not have an altered LOA and is normotensive and has not used NSAID or ibuprophen use within the previous 6 hours, does not have an allergy or sensitivity to ASA or NSAIDS, are not on anticoagulation therapy, do not have active bleeding, doe not have a history of peptic ulcer disease or GI bleed, are not pregnant, have not had a CVA or TBI in the previous 24 hours, do not have known renal impairment, and are able to take oral medications then administer 10-15mg ketorolac IM or IV (to a maximum dose of 15mg).  The maximum number of doses is 1.

Morphine: If the patient is 18 years of age or greater, has an unaltered LOA, is normotensive and does not have an allergy or sensitivity to morphine and provided that their SBP does not drop by 1/3 of its initial value after morphine is administered then administer 2-5mg morphine SC/IV to a maximum dose of 5mg.

Fentanyl: If the patient is ≥ 18 years of age, with an unaltered LOA and is normotensive and does not have an allergy or sensitivity to fentanyl, and does not have an injury to the head, chest, abdomen or pelvis administer fentanyl 25-50mcg IV (maximum dose of 50mcg) q 5 minutes to a maximum of 4 doses. Repeat doses may be administered at 5 minute intervals to a maximum of 4 doses.

Clinical Considerations: Whenever possible consider administering acetaminophen and ibuprophen together.  In patients with isolated and hip or extremity trauma, ibuprophen is preferred to ketorolac except when the patient is unable to tolerate oral medication.  If ketorolac is administered then neither acetaminophen nor ibuprophen should be administered.  Suspected renal colic patients should routinely be considered for ketorolac.

Procedure:


PEDIATRIC ANALGESIA

Indications: Mild to moderate pain may receive acetaminophen/ibuprophen or mild to severe pain may receive ketorolac for an isolated hip or extremity trauma or burns or  renal colic (with a prior history) or  acute musculoskeletal back strain or current history of cancer related pain.

Morphine: If the patient is less than 18 years of age and has a heart rate of 60 BPM or greater and is normotensive and does not have an allergy or sensativity to morphine, does not have a head injury or an injury to the abdomen or pelvis or and provided that their BP does not drop 1/3 or more of its initial value when morphine is administered then administer 0.05mg/kg morphine IV/SC to a maximum single dose of 3mg.  Repeat doses may be administered at 5 minute intervals to a maximum of 2 doses.

Mandatory Patch Point: Patch to BHP for auauthorizationn and dosage verification before administering the medication for children less than 8 years of age.