Lindsay Vargas BSN, RN, CEN January 20, 2018 …?… What's that doing in a pain management...

Lindsay Vargas BSN, RN, CENJanuary 20, 2018

Paramedic Refresher

Less Painful than this picture

Classification

Administration of narcotics

Assessment

Acute vs. Chronic

Mild

Moderate

Severe

Pain is what the patient states

Utilize additional assessment findings: vital signs, color, diaphoresis etc

Appropriate pain scales for developmental age, special needs population, and elderly

Numerical

PIPP used for infants

FLACC Face, Legs, Activity, Cry, and Consolability Helpful for infants and developmentally delayed children

Evaluate need for pain medication

Assess for type of medication to use per your agency protocol

Recent set of vital signs prior to administration

Do not push fast/can dilute some medications

Push Rate

Good rule of thumb is 1-2 minutes

Assess Vital signs pre-administration

Patient assessment

Be accurate in assessment

Don’t rely solely on a monitor

Serotonin Antagonist

Indication of management of nausea and vomiting

4mg IVP over 2-5 minutes repeated in 1 hour

Peds: 0.1 mg/kg over 2-5minutes up to 4 mg total

If your formulary includes other medications know the rate of administration

Pure Opiod agonist

Adult 2-5 mg IV slowly every 5 minutes up to 10 mg total.

Peds: 0.1 mg/kg up to 10 mg

Narcotic

Contraindications

Monitor for respiratory depression, bradycardia and hypotension

Synthetic opiate agonist

Adult:25-50 mcg IV or Nasal. May repeat q 5 minute for a total of 100 mcg

Peds: 1 mcg/kg IV or Nasal

Onset 30-60 seconds

Duration 30-60 minutes

Prolonged half life in elderly

Monitor for bradycardia and hypotension

Hey!?… What's that doing in a pain management presentation?

Chest pain management: used to improve oxygenation of ischemic tissue

Can be used when signs of hypoxia are present: sp02 less than 94%, cyanosis, dyspneic, etc.

Research shift from oxygen on all chest pain patients

Follow your protocol and use with caution

Narcotic Antagonist

Precaution in narcotic dependent patients.

30 second onset

Short duration (Monitor q 5 minutes)

1 mg up to total of 10 mg IVP, IN, IM

Can wake up aggressive

Can’t stress reassessing patients enough

Be sure to document reassessment

Adjust cares as needed based on assessment.

Know your agencies policy and practice

Witness

No Virtual wasting

Documentation

Checking your locked cabinet

Maintain integrity of lock

Ice or Heat Packs

Splinting

Positioning

Distraction

Backboard and collar◦ What is your protocol for use?