Pain

Question 1

fentanyl (Sublimaze)

Pain

Answer 1

Class
Narcotic analgesic

Adult Loading Dosage

Systolic BP greater than 90 mmHg:
1 mcg/kg SIVP/IM/IO to a single maximum dose of 100 mcq q 3 minutes prn to a total maximum of 250 mcg

Systolic BP between 80 and 90 mmHg:
0.5 mcg/kg SIVP/IM/IO to a single maximum dose of 25 mcg q 5 minutes prn to a total maximum of 250 mcg

Maintenance Dosage
Systolic BP greater than 90 mmHg only:
250 mcg/hr SIVP/IM/IO in 50 mcg increments prn

EMS Contraindications
Hypersensitivity
Monoamine oxidase inhibitor therapy within last 14 days
Systolic BP less than 80 mmHg

Notes
Should be reserved for patients with poly-trauma or a morphine allergy
Use cautiously if evidence of ETOH or drug intoxication
May cause respiratory depression; monitor vital signs closely post administration
Use with caution in myasthenia gravis

Question 2

Morphine

Pain

Answer 2

Class
Narcotic analgesic

Adult Loading Dosage
0.1 mg/kg SIVP/IM/IO to a single maximum dose of 5 mg
q 5 minutes prn to a total maximum of 20 mg

Maintenance Dosage
10 mg/hr SIVP/IM/IO in 2.5 mg increments prn
Maintenance dose time starts after loading dose administered

EMS Contraindications
Hypersensitivity
Systolic BP 90 mmHg or less

Notes
Analgesic of choice
Use cautiously if evidence of ETOH or drug intoxication
May cause respiratory depression and hypotension; monitor vital signs closely post administration
Use with caution with other drugs that are sedatives / depressants
Top

Question 3

ketamine (Ketalar)

Pain

Answer 3

Dissociative anesthetic

Mandatory OLMC – pain in hypotensive patients (systolic BP 80 mmHg or less)
Mandatory OLMC – pain refractory to morphine or fentanyl
Adult Dosage

Mandatory OLMC – 0.2 mg/kg SIVP/IO

EMS Contraindications
Hypersensitivity
Conditions where a significant elevation of blood pressure is hazardous (e.g. patients with poorly controlled hypertension, aneurysms, acute heart failure, angina, recent myocardial infarction)

Notes
Can cause transient (15 minutes) increases in heart rate and blood pressure
Can induce hypersalivation and tracheobronchial secretions
Ensure that the suction unit is available and ready

Question 4

ketorolac (Toradol)

Pain

Answer 4

Class
Non-steroidal anti-inflammatory

Adult Dosage
30 mg IV/IM No repeat dose

EMS Contraindications
Hypersensitivity to ketorolac or other non-steroidal anti-inflammatory agents
Asthma
Renal failure
Suspected intracranial bleed
History of GI bleeding
Sub-arachnoid hemorrhage (indicated by sudden onset/most severe ever headache/thunderclap)

Notes
Consider for biliary or renal colic presentations
Lower doses are required in patients weighing less than 50 kg or over 65 years of age
30 mg of ketorolac is approximately equivalent to 12 mg of morphine (IM) with a longer duration of action
Top

Pharmacology