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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?