Category Archives: Adult Analgesia

Question: In regards to the adult analgesia medical directive, it states "in patients with isolated hip or extremity trauma, ibuprofen and acetaminophen are preferred to ketorolac except where the patient is unable to tolerate oral medications." It is my understanding that together, they provide similar pain relief to ketorolac. If the patient is in severe pain, but is unable to take acetaminophen due to a contraindication (ex. due to having taken some in the past 4 hours), is it appropriate to administer ketorolac instead? Or is it still preferred to administer just the Ibuprofen at this point.

Question: The PCP adult analgesia directive is for "isolated extremity injuries", if there's more than one injury is it a contraindication? For example, burns to more than one location (shoulder and a portion of the ant chest) or an ankle and a knee injury.

Question: In Ask MAC it states : "As for Ketorolac, daily ASA is not considered anticoagulation therapy as it affect platelet function and does not result in a true anticoagulated state." So PLAVIX (clopidogrel) is also affect platelet function, even though ASA affects the cyclooxygenase 1 (COX-1) pathway, and PLAVIX affect the adenosine diphosphate (ADP) pathway, still I think both PLAVIX and ASA affect platelet function . And I think daily dose of PLAVIX also not a true anti-coagulated state and Ketorolac is not contra-indicated. Please let me know if I am right or wrong by those explanations.

Question: Under the Adult Analgesia Medical Directive, it indicates that for Mild-Moderate Pain, Acetaminophen and Ibuprofen should be considered. If the pain is mild-severe pain than ketorolac should be considered. If a patient is reporting severe pain as a result of isolated hip or extremity trauma, and the MOI is consistent with severe pain, does this mean that only ketorolac should be considered, regardless of the patient’s ability to tolerate oral medications?
The way that I read this is that Acetaminophen and Ibuprofen would not be indicated if the pain is severe.

Question: Just to clarify about Ketorolac. The indications states “localized hip OR extremity trauma”. Are we to interpret this as isolated (single) hip AND isolated (single) extremity trauma? For example, if an old lady has fallen and broken both wrists, can we administer Toradol?

Question: I had a question about the ACP Pain Management Medical Directive. I can give 4 doses of 5mg max of morphine (a total of 20mg).  If I give a loading dose of let's say 4mg to achieve the desired effect then I could give maintenance doses of 2mg every 5 min to keep the patient's pain controlled. So instead of giving 20mg over 15 min I could give it over 40 min. This way I am giving a smaller dose, hopefully meaning I have less side effects (nausea, vasodilation) and if I have a longer transport time can better manage my patient's pain for longer. I understand that Base Hospitals are very strict about giving only 4 doses. Thank you. PS: I think this is a great tool!

Question: With the expansion of Analgesia/pain relief being delivered to all paramedics. Is there going to be an addition to the standing order for the expansion of Ketorolac to the pediatric population either for ACP or PCP?

Question: My question is in regards to abdominal pain and analgesia. I was always under the understanding that as ACP's we should not be patching to a BHP for analgesia when a patient is experiencing severe abdominal pain. I have come into discussion with other ACP's where some have and some have not patched for analgesia in severe abdominal pain. I am a bit confused about this particular situation. Should I be patching a BHP for analgesia orders for a patient experiencing severe abdominal pain?

Question: My question relates to analgesia that I can provide patients as an ACP. If I have a patient that meets the indications and conditions for Morphine or Fentanyl under the ACP Core Pain Medical Directive, and if the patient’s discomfort is improving with the administration of the above narcotic analgesic, is it a requirement that I must proceed to administer Ketorolac?

Question: A question arose today after a call where a patient clearly did not meet the protocol for Ketorolac. Upon reviewing the contraindications for this protocol, what exactly are being considered to be NSAIDs? The MEDList on the website included Ibuprofen, Naproxen, Celebrex, etc. but what about ASA? Tylenol? Excedrin? I was under the impression that both ASA and Tylenol were considered NSAIDs? My partner and I could not come to a conclusion and wanted further clarification.

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