Pediatric Analgesia | SWORBHP Ask MAC

Category Archives: Pediatric Analgesia

September 29, 2022 SWORBHP Category: Adult Analgesia, Pediatric Analgesia | Date: 2022-september-29

Have alternative pain control options such as oral morphine and nitrous oxide been (re)considered recently for pre-hospital administration? If not, what's the reasoning?

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June 20, 2022 SWORBHP Category: Miscellaneous, Adult Analgesia, Pediatric Analgesia | Date: June-20-2022

Just wondering, I have heard of a few coworkers putting the cardiac monitor on when giving acetaminophen and ibuprofen and others are not putting it on. I was under the impression that the monitor had to be on prior to giving medications. Is this a must or not?

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June 20, 2022 SWORBHP Category: Adult Analgesia, Pediatric Analgesia | Date: June-20-2022

I just have a question regarding analgesics. A contraindication for acetaminophen is “use of it within the last 4 hours”. Let’s say for an adult patient they took 500mg prior to EMS arrival, would it then be okay to administer an additional 500mg to complete the full max single dose of 1000mg or should you withhold the acetaminophen in honour of the contraindication?

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April 27, 2021 SWORBHP Category: Adult Analgesia, Pediatric Analgesia | Date: 27-Apr-2021

As far as the contraindications for ketorolac and ibuprofen, what are the medications that are classified as anticoagulation therapy? I know daily ASA is not but are all blood thinners? Or just specific ones? We have been seeing a lot of eliquis and xarelto lately for example.

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November 10, 2020 SWORBHP Category: Adult Analgesia, Pediatric Analgesia | Date: 10-November-2020

I have a question regarding analgesic administration in regards to abdominal pain (ex diverticulitis, hernia). If the pt is complaining of abdominal pain stating "it feels just like my diverticulitis acting up" Or due to hernia pain with evidence of a protruding hernia, would it be appropriate to consider analgesic medication if no contraindications are met? Although you are not 100% certain of the underlying cause in the pre hospital setting

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March 28, 2019 SWORBHP Category: Adult Analgesia, Pediatric Analgesia | Date: 28-Mar-2019

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

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Drug	Route	Onset	Peak	Duration
Ibuprofen	PO	30min	2-4h	6-8h
Ketorolac	IM	10min	1-2h	4-6h
Ketorolac	IV	10min	1-2h	4-6h

March 28, 2019 SWORBHP Category: Adult Analgesia, Pediatric Analgesia | Date: 28-Mar-2019

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

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December 17, 2015 SWORBHP Category: Pediatric Analgesia | Date: 17-Dec-2015

Question: An ACP is doing an inter-facility transfer of a 16 year old patient with a fracture. During the journey the patient's pain becomes severe in nature. The sending facility had been administering 1mg doses of Morphine with good effect however the medical directives would indicate that the paramedic should administer a 3mg dose of Morphine.

Can the paramedic elect to give a lower (1mg) dose since it has been already proven to be "the right dose" for this patient, or does this require consultation with a BHP

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Pediatric Analgesia

October 23, 2015 SWORBHP Category: Adult Analgesia, Pediatric Analgesia | Date: 23-Oct-2015

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?

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Answer: The OBHG Medical Advisory Council must take many factors into consideration when developing medical directives such as evidence based medicine, benefits of the directive versus risks and costs to paramedic services. That being said there have been many changes surrounding analgesia directives (pediatric analgesia for ACP, PCP/ACP adult analgesia) in the past few years, including the introduction of new analgesics and the revision of indications and contraindications for these analgesics. As QA data is collected, medical council incorporates this information into the further development and revision of the directives to ensure that the maximum benefit is received by patients, while minimizing the risks/adverse outcomes (as exemplified by the recent revisions to the adult analgesia directive).

In response to your question, the short answer is that the balance of evidence currently suggests that the use of ketorolac in the pediatric population is not indicated. The FDA (U.S. equivalent of Health Canada) has placed a black box warning (the adverse effects must be weighed carefully against the benefits) on ketorolac and the safety and efficacy in children has not been established (1). In addition, the pediatric population often requires medication doses to be based on weight. As a result of this, these are instances that are at higher risk for medication errors. This risk must be weighed against the benefit of the drug in question’s effect on morbidity and mortality. When it comes to ketorolac, the benefit of a medication delivered by an IM route (which can be a very stressful, uncomfortable and fear inducing event for this population group) must be weighed against the risk (potential drug dosing error, psychological stress of IM injections in the pediatric population). However, medicine is ever evolving and as more evidence is collected, the scope of analgesia may extend further into the pediatric population.

Product Monograph: ketorolac tromethamine injection, USP (Keotorolac tromethamine) 30mg/mL, NSAID analgesic, Hospira Healthcare Corporation, Date of Revision Dec 17, 2012

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May 13, 2014 SWORBHP Category: Adult Analgesia, Moderate to Severe Pain, Pediatric Analgesia | Date: 13-May-2014

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!

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