Category Archives: Adult Analgesia

Question: Is narcotic analgesia recommended for patients currently on methadone? Would there be any synergistic effect? Would it cause the patient to relapse?

Question: I have a few questions regarding the new analgesia and moderate to severe pain medical directives.

1. Could you be more specific on what you mean with "current active bleed"? Would this include the possible bleeding attributed with fractures? Blood in urine from damage caused by known kidney stones? Menstrual bleeding?

2. Could you elaborate on the condition of "patient must remain NPO or is unable to take oral medications" for Ketorolac? Does this mean it is only to be given if Tylenol/Ibuprofen cannot be given orally, or they should remain NPO after medication administration?

3. Should we avoid giving Tylenol/Ibuprofen/Ketorolac if patient has already self-medicated with other pain medications? i.e. Percocet, Demerol, etc.

Thank you in advance for your clarification.

Question: With the new PCP pain medical directives, I realize there has been a lot of debate over the age range. That being said, if we end up with a patient outside the age range (within reason), in severe pain, who does not meet any other contraindications, if a BH patch would be advisable for the possible administration of ketoralac? I realize that the patch orders are generally doctor specific but I was just unsure if these ages are set in stone or given special circumstances and orders if the rules can be bent. Thanks for the help!

Question: Couple of questions regarding the Musculoskeletal pain protocols:

To be clear, we are to give Acetaminophen and Ibuprofen OR Ketorolac. There is no case where we can give all 3 medications, as Ketorolac requires NPO?

Also Cardiovascular Disease means anyone with any hint of HTN, Athersclerosis, Dysrrhthmias, Heart Failure, and Peripheral Vascular issues, anything of the sort are not to get Ibuprophen?

And lastly for Ketorolac, is a daily ASA considered anticoagulation therapy?

Question: Is there any chance we will start giving acetaminophen to children with fevers (a temperature above 38 degrees) in the future? If not, what are the reasons why we can't add this to our protocols?

Question: I have a question regarding the Analgesia and Moderate to Severe Pain medical directives for torodol and narcotics. Can a narcotic analgesia and torodol be administered to the same patient on the same call if the ACP determines the patient's pain is severe enough and the properties of both analgesics would be beneficial given the situation? Or are we best to pick the most appropriate analgesia and possible consult with a BHP? Thanks for your time and input!

Question: My question is about pain management. Our directive states a maximum of 4 doses of 25-50mcg fentanyl (200mcg max) or 2-5mg morphine. (20mg max). Is there a reason we could not just have a max total dose of 200mcg/20mg and be able to give, say, 8x25mcg fentanyl q5? I feel that with the increasing frequency of offload delays it could be beneficial to the patient for us to have the ability to spread the maximum dosage out over a longer duration.

Question: This question is regarding not giving Narcan to a DNR patient. Obviously, if there is not an underlining medical issue (e.g. terminal CA) and a patient ODs, even with a DNR, we attempt to reverse any issues. However, if the patient does have a medical issue with a DNR, has decided to OD to commit suicide and is in a pre-arrest / arrested state, is it reasonable to assume that since they are breaking the law, that the DNR can no longer be valid?

Question: Recent call of a 40 years old woman with a past history of renal colic and experiencing intense low back pain that she likens to an exacerbation. She is a small woman at about 45 kg and a candidate for narcotics under the standing order for pain relief. Two questions: Firstly, we were unable to establish an IV after 2 attempts and the standing order specifies only the IV route of administration. Can morphine and/or fentanyl be given IM in this instance as a standing order? Secondly, her initial BP was 90/60. Given the patient's size and her statement of usually having a low BP, can this reading of 90/60 be considered as normotensive? What if it was 85/60? Thanks in advance for your answer.

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