About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.13 - Pain and Nausea Management
EMT-Advanced (Standing Orders)
Adult:
- Ondansetron 4 mg PO (Oral Disintegrating Tablet (ODT) is the preferred route) IV/IO/IM.
Pediatric:
- Ondansetron for child under or up to 25 kg 2 mg PO by Oral Disintegrating Tablet (ODT).ODT is the preferred route /IV/IM; for a child over 25 kg, 4 mg PO by ODT(the preferred route)/IV/IM.
EMT-Paramedic (Standing Orders)
Adult:
- Acetaminophen 650-1000 mg IV or PO.
- Ibuprofen 600 mg PO.
- Ketorolac 15 mg IV or 30 mg IM.
- Fentanyl 1 mcg/kg slow IV/IO/IM weight based (kg) to a max. of 150mcg (150kg) or Fentanyl 1 mcg/kg IN weight based (kg) to a max. of 150mcg (150kg).
- Morphine Sulfate 0.1mg/kg IV/IO/IM/SC,(max 10 mg).
- Ketamine 0.3-0.5 mg/kg IV/IO SLOWLY-may repeat dose one time in 10 minutes or 1 mg/kg IM/IN-may repeat IM/IN dose one time in 20 minutes.
- For patients requiring electrical therapy (cardioversion or pacing) see7.6 Sedation and Analgesia for Electrical Therapy-Adult
Consider ketamine.
Pediatric:
- Acetaminophen 15 mg/kg IV or PO to max 1000 mg.
- Ibuprofen 10 mg/kg PO to max 600 mg.
- Ketorolac 0.5 mg/kg IV or IM to max 15 mg.
- Fentanyl 1 mcg/kg. to max. 150 mcg slow IV/IO/IM or Fentanyl 1 mcg/kg. to max. 150 mcg IN.
- Morphine Sulfate 0.1 mg/kg IV/IO/IM/SC (maximum individual 5 mg)
EMT-Paramedic (Medical Control)
- Additional doses of above medication
Note:
Pain Management can include positioning, ice packs and other nonpharmacological treatments.
Note:
All pain medications have contraindications-do not administer medications in such circumstances.
These contraindications include but are not limited to:
Ketorolac and ibuprofen are contraindicated in head injury, chest pain, abdominal pain, or in any patient with potential for bleeding, ulcer, or renal injury; likely to need surgery
Acetaminophen is contraindicated in patients with liver failure.
Ketorolac and ibuprofen are contraindicated in pregnancy.
These contraindications include but are not limited to:
Ketorolac and ibuprofen are contraindicated in head injury, chest pain, abdominal pain, or in any patient with potential for bleeding, ulcer, or renal injury; likely to need surgery
Acetaminophen is contraindicated in patients with liver failure.
Ketorolac and ibuprofen are contraindicated in pregnancy.
Caution:
Ondansetron is contraindicated in patients with prolonged QT interval.