Pain Management

Assessment

Pediatric Pearls:	Signs & Symptoms:	Differential:
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes.  □ Uses faces scale in younger patients □ Consider IN meds for kids without an IV.	□ Severity (Pain scale)  □ Quality  □ Radiation  □ Relation to movement  □ Respirations  □ Reproducible  □ Increased upon palpation	□ Per the specific protocol  □ Musculoskeletal  □ Visceral (abdominal)  □ Cardiac  □ Pleural / Respiratory  □ Neurogenic  □ Kidney stone

Clinical Management Options

EMT-B

• Bleeding control  • Oxygen, target SpO2 92 – 96%  • Pain scale assessment 0-10, Wong-Baker faces for pediatrics, FLACC for infants  • Splinting/bandaging needed  • Ice pack as needed

Paramedic

• Consider vascular access  • Isotonic Crystalloid as needed  • Consider medications for pain control • Acetaminophen/Ibuprofen for mild to moderate pain • Fentanyl for severe pain, MAP>65 and no respiratory depression • Consider pain-dose Ketamine infusion for pain that is not improved with fentanyl • Monitor ECG and ETCO2 if fentanyl or Ketamine was provided

Pearls

• Pain severity is a vital sign to be recorded pre and post pain intervention, especially medications. 
• Vital signs should be obtained pre and 5-minutes post all medications. 
• We carry Ketamine 100mg/cc. Ketamine needs to be diluted in normal saline.
• Monitor patient closely for over sedation, refer to Overdose COG if needed 
• Be cautious with pain medications in patients with head injury 
• Do not administer Acetaminophen to patients with history of liver disease or known to have consumed large amounts of ETOH. 
• Fentanyl should be reserved for acute pain. 
• Controlled substances are discouraged for non-traumatic back pain.