Pain Directives

Question 1

What two drugs can be administered for the adult pain standing order?

Answer 1

Morphine or fentanyl

Question 2

What are the conditions for fentanyl in the adult pain medical directive?

Answer 2

The patient must be:

Equal to or greater than 18
Unaltered
Normotensive

Question 3

What are the conditions for morphine in the adult pain medical directive?

Answer 3

The patient must be:

Equal to or greater than 18
Unaltered
Norm ostensible

Question 4

What are the contraindications to fentanyl in the adult pain medical directive?

Answer 4

Allergy or sensitivity to fentanyl
Injury to the head, chest, abdomen or pelvis
SBP drops by 1/3 or more of its original value

Question 5

What are the contraindications for Morphine in the adult pain medical directive?

Answer 5

Allergy or sensitivity to morphine
Injury to the head, chest, abdomen or pelvis
SBP that drops by 1/3 or more of its initial value

Question 6

What is the dosing of Fentanyl in the adult pain medical directive?

Answer 6

25-50 mcg fentanyl IV q 5 minutes to a maximum of 4 doses.

Max single dose 50 mcg

Question 7

What is the dosing for morphine in the adult pain medical directive?

Answer 7

2-5 mg morphine IV q 5 minutes to a max of 4 doses.

Max single dose of 5 mg

Question 8

What is the adult pain medical directive?

Answer 8

The patient must be in severe pain AND have an isolated hip or extremity fracture or dislocation, major burns, current history of cancer related pain, or renal colic with prior history or acute musculoskeletal back strain or ongoing pacing.
Must be 18 or older, unaltered and normotensive

Must have no allergy or sensitivity to morphine or fentanyl. No injury to the head, chest, abdomen or pelvis. Bp can’t drop by 1/3 or more

Fentanyl 25-50 mcg q 5 min max 4 doses. Or
Morphine 2-5 q 5 min max 4 doses

Question 9

What are the indications for the paediatric pain medical directive?

Answer 9

Severe pain AND isolated hip or extremity fracture or dislocation OR major burns OR current history of cancer related pain.

Question 10

What are the conditions for the pedi attic pain medical directive?

Answer 10

Less than 18 years old
Unaltered
HR more than 60/min (61 and up)
Age related normotensive

Question 11

What are the contraindications to morphine in the paediatric pain medical directive?

Answer 11

Allergy or sensitivity
Injury to the head, chest, abdomen or pelvis
SBP drops by 1/3 or more of initial value

Question 12

What do you have to do before administering morphine in the paediatric pain medical directive?

Answer 12

Patch

Question 13

What is the dosing of morphine in the paediatric pain medical directive?

Answer 13

0.05 mg/kg ( to a max of 3 mg)
IV or SC
Q 5 minutes
Max 2 doses

Question 14

In what ways can you administer fentanyl or morphine in the adult pain standing order?

Answer 14

IV only

Question 15

How can you administer morphine in the paediatric pain standing order?

Answer 15

IV or SC

But….. Since it is a patch consider asking for IN

Question 16

What are the indications for the analgesia medical directive? (Auxiliary directive)

Answer 16

Isolated hip OR extremity trauma
AND
Pain

Question 17

What two drugs can be administered for the analgesia medical directive?

Answer 17

Tylenol and Advil

Question 18

What are the conditions of administering Tylenol for the analgesia medical directive?

Answer 18

18 and older

Unaltered

Question 19

What are the conditions of administering Advil for the analgesia medical directive?

Answer 19

18 to 49 years of age. (Equal to or greater than 18 and less than 50)
Unaltered

Question 20

What are the contraindications for Tylenol in the analgesia medical directive?

Answer 20

Tylenol use within the past 4 hours
Allergy or sensitivity to Tylenol
Signs or symptoms of intoxication
Active vomiting
Major burns
HX of liver disease

Question 21

What are the contraindications for Advil in the analgesia medical directive?

Answer 21

Advil or NSAID use within the previous 6 hrs
Allergy or sensitivity to ASA or NSAID's
Active vomiting
Current active bleeding
Major burns
HX of peptic ulcer disease or GI bleed
Pregnant
HX of cardiovascular disease
Asthmatic ( unless prior use of ASA or other NSAID)
CVA or TBILISI in the previous 24 hrs

Question 22

What is the dosing for Tylenol in the analgesia medical directive?

Answer 22

One dose of 960-1000 mg

Max dose 1000mg

Question 23

What is the dosing for Advil in the analgesia medical directive?

Answer 23

One dose of 400mg

Max dose 400

Question 24

What are the clinical considerations for Advil and Tylenol in the Analgesia medical directive?

Answer 24

Whenever possible administer Advil and Tylenol together
This does not replace the core pain medical directive and this directive can be used in conjunctive with the pain medical directive

Question 25

What is the analgesia medical directive?

Answer 25

``` For isolated hip or extremity trauma and pain Patient must be 18 or older for Tylenol and between 18 and 49 for Advil Patient must be unaltered Tylenol: Must not have had Tylenol in past 4 hrs No allergy or sensitivity to drug No s/s intoxication No active vomiting No major burns No HX liver disease ``` Advil: No Advil or NSAID in past 6 hrs No allergy or sensitivity to ASA or NSAID's No active vomiting No current active bleeding No major burns No HX of peptic ulcer disease or GI bleed Not pregnant No HX cardiovascular disease Not asthmatic (unless prior use of ASA or NSAID) No CVA or TBI in past 24 hrs Dosing Tylenol 960-1000mg X11 Advil 400 mg X1 Give both together if poss Can also use with morphine/ fentanyl

Question 26

What are the indications for the moderate to severe pain medical directive (auxiliary)?

Answer 26

Moderate to severe pain AND Isolated hip or extremity trauma OR major burns OR current history of cancer related pain OR renal colic with prior history OR patients with acute musculoskeletal back pain

Question 27

What are the conditions for ketorolac for the moderate to severe pain medical directive (auxiliary)?

Answer 27

Between 18 and 49 years old Unaltered Normotensive Patient must remain NPO or is unable to take oral medications

Question 28

What are the contraindications for ketorolac?

Answer 28

``` NSAID or Advil use in past 6 hrs Allergy or sensitivity to ASA or NSAIDs Pt is on anticoagulant therapy Current active bleeding CVA or TBI in the past 24 hrs Asthmatic (unless prior use of ASA or other NSAID) Pregnant Known renal impairment ```

Question 29

What is the dosing of ketorolac?

Answer 29

30 mg IM/IV | MAX 1 dose

Question 30

What are the clinical considerations for ketorolac?

Answer 30

This directive may be used in conjunction with the core directive for pain (morphine/fentanyl)

Question 31

What are the indications for the adult pain medical directive?

Answer 31

Severe pain AND Isolated hip or extremity fractures or dislocations OR major burns OR current history of cancer related pain OR renal colic with prior history OR patients with acute musculoskeletal back strain OR ongoing transcutaneous pacing