Category Archives: Adult Analgesia

If I want a faster onset of pain relief can I go straight to Ketorolac IV?

Are we allowed to give acetaminophen and ibuprofen to someone who has a headache under the pain directive? I had 2 different patients not too long ago and both were complaining of a headache. One patient just ended up having just a headache while the other patient whom had a headache over several days with no facial droop, slurred speech, equal pupils and equal bilateral grip strengths turned out to be a bleed. Would it be ok to just give acetaminophen to our patients complaining of a headache and hold off on the ibuprofen? Headache is not a contraindication for the pain directive so this is why I am asking.

Can I only give Fentanyl if my patient doesn’t qualify for Morphine?

Can Morphine be mixed in 50 ml mini bags for easier administration & easier titration?

Question: In relation to the Adult Analgesia directive, one of the indications is "acute musculoskeletal back strain", does this include injuries such herniated discs, radiculopathies etc.?

Question: If we are presented with a hypoglycemic patient that demonstrates signs and symptoms of a TIA/CVA (slurred speech, inability to hold arms/legs up or due to confusion a grip test) and once the hypoglycemia is reversed with treatment and those signs and symptoms are gone, can we now deliver Ibuprofen/Acetaminophen or Ketorolac if the patient complains of CA related pain or muscle strain as per the Adult Analgesic Protocol?

Question: This question is in regards to hypoglycemia mimicking a stroke. You arrive on scene and the patient is presenting with the classic signs of a stroke such as facial droop, arm drift etc. Patient is out of the stroke protocol since GCS was <10, and the patient was terminally ill due to cancer, with a valid DNR. I obtain a BGL and the BS comes back as a 3.0mmol, so I correct the hypoglycemic event. Moments later a second BS was taken and it comes back as 4.1mmol. Another stroke assessment was done, with no signs and or symptoms of a stroke. Patient then complains of severe cancer related pain in her abdomen. My question is now, would I have been save in not giving the patient any NSAIDS since one of the contraindications was "CVA or TBI within previous 24 hours?" I ended up giving Acetaminophen since I thought doing something is better than nothing for the patient’s abdomen pain. Along with that, I didn't know if the patient experienced both a CVA and a Hypoglycemic event together at the same time, or if the patient experienced a stroke hidden in with the hypoglycemic event. What are your thoughts?

Question: In the 2015 ALS Companion Document Version 3.3 pg 13, it states this: "A clinical consideration states "Suspected renal colic patients should routinely be considered for Ketorolac". More correctly, this statement should include NSAIDS like Ibuprofen. Ketorolac is preferred when the patient is unable to tolerate oral medication.

There is some confusion over the interpretation of this. I read this statement as suspected renal colic patients should be routinely screened for an NSAID (not just Ketorolac), and therefore should be given ibuprofen first instead, unless the patient cannot tolerate oral medication. My PPC is saying differently that you should be considering Ketorolac first, since the companion document cannot overrule the ALS Directives. What is the true purpose of this statement then?

Question: This question may be a very rare situation but I have not been able to get an answer from any paramedics I have asked. As per the "Patching" section in the introduction of the ALS PCS the literature states "BHP cannot be reached despite reasonable attempts by the paramedic to establish contact, a paramedic may initiate the required treatment without the requisite online authorization if the patient is in severe distress and, in the paramedic’s opinion, the medical directive would otherwise apply". In a situation where a cardioversion is required and the unstable patient is still conscious, it is fairly common practice to ask for sedation and pain control (i.e. Morphine/Midazolam) along with orders for cardioversion. If multiple BH patches cannot be completed and in the paramedics opinion cardioversion is required for the unstable but conscious patient, are we able to administer sedation and pain control? I ask this because there is not a directive that directly deals with pain and sedation prior to delivering the cardioversion, but is common to ask for such direction.

Question: Can you give Ketorolac to a HTN patient (180 systolic)? The PCP directive states Normotension.

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