Pain Management

Applies to: Patient presents with a painful condition that would benefit from treatment with an analgesic. This
includes DNR/MOLST patients and patients being pre-medicated for a painful procedure.

Exclusion Criteria: Medication specific hypersensitivity/allergy. Active Labor.

History to consider

• Age
• Location
• Duration
• Severity (1 - 10)
• If child use Wong-Baker faces scale
• Past medical history
• Medications
• Drug allergies

Signs and Symptoms to note

• Severity (Pain scale)
• Quality
• Radiation
• Relation to movement
• Respirations
• Reproducible
• Increased upon palpation

Differentials to consider

• Per the specific protocol
• Musculoskeletal
• Visceral (abdominal)
• Cardiac
• Pleural/ Respiratory
• Neurogenic
• Renal (colic)

Pearls

• Do not administer Acetaminophen to patients with history of liver disease or known to have consumed large amounts of ETOH. 
• Fentanyl, Morphine and Ketamine should be reserved for acute pain.
• For patients in Moderate pain for instance, you may use the combination of an oral medication and parenteral if no contraindications are present.
• Ketamine
  • May use Ketamine in combination with opioids to limit total amount of opioid administration
  • Avoid in patients who have cardiac disease or uncontrolled hypertension.
  • Avoid in patients with increased intraocular pressure such as glaucoma.
  • Avoid use in combination with benzodiazepines due to depressed respiratory drive

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References

Protocols

• Nausea / Vomiting

Pharmacology

• Fentanyl Citrate
• Morphine
• Ketamine
• Acetaminophen
• Ofirmev
• Ibuprofen

Procedures

• Vascular Access
• Pain Assessment