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Patient Treatment Protocols > 10.135 -- Pain Management > Flashcards

10.135 -- Pain Management Flashcards

1
Q

For adults patients with mild pain, what two medication options should be considered?

A
  1. Acetaminophen – 325 mg to 1000 mg PO
  2. Ibuprofen – 200 to 600 mg PO
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2
Q

Controlled medications (such as opioids and ketamine) should be avoided in patients with which complaints?

A

Patients with:

  1. Active labor
  2. Headache
  3. Non-traumatic neck or back pain
  4. Chronic pain (head, neck, back, abdominal/pelvic pain, fibromyalgia)
  5. Dental pain
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3
Q

What vital signs are most important to monitor with administration of pain medication?

A
  1. SpO2
  2. ETCO2
  3. Cardiac rhythm
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4
Q

True or false: Opioids and dissociative medications such as ketamine can be used in the same patient to achieve pain relief if it is deemed necessary.

A

True

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5
Q

What is the adult dose of intravenous acetaminophen?

A
  1. 1000 mg IV push over 5 minutes
  2. 1000 mg IV infusion over 10 to 20 minutes
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6
Q

What age range is appropriate for patients receiving ketorlac, per our protocol?

A

2 to 80 years

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7
Q

What is the adult intramuscular dose of ketorlac?

A

30 mg IM

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8
Q

What is the adult intravenous dose of ketorlac?

A

15 mg IV

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9
Q

What are two non-opioid pain medications that we carry?

A
  1. Acetaminophen
  2. Ketorlac
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10
Q

What are three opioid medications that we are allowed to administer in our pain management protocol? (Some medications may only be currently available to AMR.)

A
  1. Fentanyl
  2. Morphine
  3. Dilaudid (Hydromorphone)
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11
Q

What is a dissociative medication in our pain management protocol that is available for us to administer?

A

Ketamine

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12
Q

What is the maximum amount of fentanyl that we can administer to an adult?

A

500 mcg

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13
Q

If a patient is not hypotensive, does not have altered mental status, or does not have respiratory depression, what is the initial dose of fentanyl for adults?

A

50 to 100 mcg IV/IM/IN

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14
Q

If an adult patient is not hypotensive, does not have altered mental status, or does not have respiratory depression, what are the additional amounts of fentanyl we can give AFTER an initial dose has been administered?

A
  1. 25 to 50 mcg IV/IN
  2. 50 to 100 mcg IM
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15
Q

An adult patient has been administered an initial dose of fentanyl and is still experiencing moderate to severe pain. How long must we wait until between additional doses?

A

10 to 15 minutes until the maximum amount is administered.

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16
Q

If an adult patient has a systolic blood pressure that is under ______ mmHg, a reduced amount of 25 micrograms can be administered by all routes.

A

100

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17
Q

If an adult patient has altered mental status or respiratory depression, how much fentanyl can be administered as the initial dose?

A

25 micrograms IV/IM/IN

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18
Q

If an adult patient is hypotensive, has altered mental status, or has respiratory depression, what are the additional amounts of fentanyl we can give AFTER an initial dose has been administered?

A

25 to 50 micrograms IV/IM/IN

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19
Q

Do not administer hydromorphone to an adult patient if the patient’s systolic blood pressure is less than _____ mmHg.

A

100

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20
Q

What is the maximum dose of hydromorphone that can be administered?

A

2 milligrams

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21
Q

How often can hydromorphone be administered to an adult patient?

A

Every 10 to 15 minutes until the maximum amount is administered.

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22
Q

What is the dose of hydromorphone for adult patients? (Hint: The initial dose and all subsequent doses are the same amount.)

A
  1. 0.25 to 0.5 mg IV
  2. 0.5 to 1.0 mg IM
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23
Q

What is the only pain medication that can be intranasally?

A

Fentanyl

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24
Q

What is the only medication that can be administered through a breath actuated nebulizer?

A

Ketamine

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25
Q

What is the maximum amount of morphine that can be administered to an adult patient?

A

20 milligrams

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26
Q

How often can morphine be administered to an adult patient?

A

Every 15 to 20 minutes.

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27
Q

What is the initial dose of morphine for adult patients?

A
  1. 2 to 8 milligrams IV
  2. 5 to 10 milligrams IM
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28
Q

An adult patient has been administered an initial dose of morphine and is still experiencing moderate to severe pain. What amount of morphine can be administered to the patient for any subsequent doses?

A
  1. 2 to 8 milligrams IV
  2. 5 milligrams IM
29
Q

True or false: Acetaminophen potentiates the analgesic effect of opioids, and they can be given together.

A

True

30
Q

Ketamine can be repeated only once after ___________ minutes in adult patients.

A

30

31
Q

What is the adult dose of ketamine when it is administered via a breath actuated nebulizer (BAN)?

A

1 mg/kg

32
Q

When administering ketamine through a breath actuated nebulizer, how much saline should be added to the medication reservoir?

A

Enough saline should be added so that the total amount of fluid is 5 mL.

33
Q

When administering ketamine IV or IO push, the medication must first be diluted with normal saline so that both fluids equal a minimum of ________ milliliters.

A

10

34
Q

Ketamine should not be readministered if a patient develops ___________ symptoms.

A

Psychiatric

35
Q

When administering ketamine through an infusion, the medication must first be diluted with normal saline so that both fluids equal a minimum of ________ milliliters.

A

100

36
Q

What is the adult intravenous dose of ketamine?

A

12.5 mg to 25 mg slowly over five minutes

37
Q

What is the adult intraosseous dose of ketamine?

A

12.5 mg to 25 mg slowly over five minutes

38
Q

What is the adult intramuscular dose of ketamine?

A

25 mg to 50 mg

39
Q

What is the adult intravenous infusion dose of ketamine?

A

12.5 mg to 25 mg over 15 minutes

40
Q

Do not give oral medication to patients with:

A
  1. Abdominal pain
  2. Open or obviously angulated fractures
41
Q

Ketamine should not be given to patients with the following health conditions or history:

A
  1. Schizophrenia
  2. Psychosis
  3. Pregnancy
  4. Non-traumatic chest pain
42
Q

What is the maximum dose of acetaminophen for pediatric patients?

A

1000 mg

43
Q

Acetaminophen and ibuprofen are only allowed to be given to pediatric patients in this form.

A

Liquid

44
Q

What is the dose of acetaminophen for pediatric patients?

A

15 mg/kg

45
Q

What is the maximum dose of ibuprofen in pediatric patients?

A

600 mg

46
Q

What is the dose of ibuprofen in pediatric patients?

A

10 mg/kg

47
Q

True or false: Ketorlac administration can be repeated in pediatric patients.

A

False

48
Q

What is the maximum dose of ketorlac in pediatric patients?

A
  1. 30 mg IM
  2. 15 mg IV
49
Q

What is the dose of ibuprofen in pediatric patients?

A
  1. 1 mg/kg IM
  2. 0.5 mg/kg IV
50
Q

In pediatric patients, what route is preferred if there is no IV available?

A

Intranasal

51
Q

What is the maximum dose of fentanyl in pediatric patients?

A

4 mcg/kg IV/IN/IM

52
Q

An initial dose of fentanyl has been administered to a pediatric patient, and the patient is still experiencing moderate to severe pain. The patient has an IV. What amount of intravenous fentanyl can be administered for subsequent doses?

A

0.5 mcg/kg to 1 mcg/kg

53
Q

An initial dose of fentanyl has been administered to a pediatric patient. How long must EMS wait until another dose can be administered?

A

10 to 15 minutes for all routes

54
Q

An initial dose of fentanyl has been administered to a pediatric patient, and the patient is still experiencing moderate to severe pain. The patient does not have an IV. The initial dose was provided intramuscularly by the patient’s parents’ request. What amount of fentanyl can be administered to the patient for additional doses?

A

1 mcg/kg to 2 mcg/kg

55
Q

An initial dose of fentanyl has been administered to a pediatric patient, and the patient is still experiencing moderate to severe pain. The patient does not have an IV, and the patient’s parents do not want the patient to receive a “shot.” The patient is following commands. What amount of intranasal fentanyl can be administered to the patient for additional doses?

A

1 mcg/kg

56
Q

Hydromorphone should only be administered to patients that are at least _______ year(s) of age.

A

One

57
Q

What is the maximum amount of hydromorphone that can be administered to a pediatric patient?

A

2 mg

58
Q

An initial dose of hydromorphone has been administered to a pediatric patient. How long must EMS wait until another dose can be administered?

A

15 to 20 minutes

59
Q

What is the dose for hydromorphone in pediatric patients?

A
  1. 0.01 mg/kg IM
  2. 0.01 mg/kg IV
60
Q

Hydromorphone is not preferred in young infants or toddlers if _________ or _________ is available.

A
  1. Fentanyl
  2. Morphine
61
Q

An initial dose of morphine has been administered to a pediatric patient. How long must EMS wait until another dose can be administered?

A

15 to 20 minutes

62
Q

What is the maximum dose of morphine in pediatric patients?

A
  1. 20 mg IV
  2. 20 mg IM
63
Q

What is the dose for morphine in a pediatric patient?

A
  1. 0.1 mg/kg IV
  2. 0.1 mg/kg IM
64
Q

Do not administer fentanyl or morphine to a pediatric patient if the patient is __________.

A

Hypotensive

65
Q

Ketamine cannot be administered intravenously to patients under the age of _________ for pain management.

A

15

66
Q

What is the maximum dose of ketamine that can be administered to a pediatric patient?

A

25 mg

67
Q

What is the dose for intravenous ketamine in a pediatric patient?

A

0.3 mg/kg

68
Q

What is the dose for ketamine administered via a breath actuated nebulizer (BAN) in a pediatric patient?

A

1 mg/kg

69
Q

Intravenous and intraosseous ketamine must be pushed slowly, over ______ minutes.

A

Five

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