Questions and Answers
What is the Pain Assessment Scale used for?
Patients can be given pain medication if their systolic blood pressure is greater than 90 mmHg.
True
What medication can be given to reduce nausea and vomiting?
Ondansetron (Zofran)
How often can Morphine Sulfate be administered?
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Patients with a head injury should receive pain medications without consulting Medical Control.
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What is the maximum dose of Fentanyl that can be administered?
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Which one of the following is a sedative that can be used for anxious patients?
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Midazolam dosage for anxiety ranges from ______ mg to ______ mg.
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What action should be taken if a blood transfusion reaction is noted?
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What is the preferred IV site for blood administration in adults?
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Blood products must be administered or discarded within ______ hours once removed from 2-8 degrees Celsius environment.
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Study Notes
Pain Control Protocol
- Pain is the most frequent complaint from patients; effective control can ease anxiety and discomfort.
- Proper assessment of pain severity is essential for effective relief.
- Use Pain Assessment Scale (0-10) or Wong-Baker Faces Pain Rating Scale for evaluation.
- Position patients in a comfortable manner and provide reassurance.
Treatment and Interventions for Pain
- Ice or splinting may be considered as initial pain relief measures.
- Reassess pain levels regularly.
- Pain medications may be administered with systolic BP > 90 mmHg.
- Morphine Sulfate: 2-5 mg IV every 5 minutes, or 2-5 mg IM every 15 minutes if IV access fails.
- Ondansetron (Zofran): 4 mg IV/IM for nausea, can be repeated every 15 minutes.
- Alternatives if Morphine is ineffective:
- Fentanyl: 50 mcg IV over 2 min, repeat once in 5 minutes for up to 100 mcg; or IM for the same dosage.
- Hydromorphone: 0.5-1 mg IV, repeat once total.
- Ketamine: 30 mg IV for patients over 15, may repeat in 15 minutes.
- Narcan 2.0 mg IV/IN should be readily available.
Monitoring and Safety
- Watch for respiratory depression after narcotic administration; monitor BP closely.
- Confirm no allergies to medication before administration.
- Patients with head injuries or unstable vitals need direct orders for pain medication administration.
- In patients with renal failure, reduce Fentanyl dose to 25 mcg with a max of 50 mcg.
Patient Sedation Protocol
- Sedation may be necessary for safe transport and airway maintenance.
- Assess for anxiety and attempt verbal reassurance.
- Use Midazolam: 2.5-5 mg IV/IN/IM every 5 minutes as needed; administer IV slowly over 2 minutes.
- Administer Lorazepam or Diazepam for ongoing anxiety as indicated.
Sedation for Intubated Patients
- Propofol: maintain or adjust IV infusion from transferring facility; increase dosage slowly.
- Use Midazolam as needed for anxiety.
- Assess for necessity of paralytic agents before use.
Excited Delirium Management
- Prioritize crew safety and prepare restraints.
- Administer Ketamine for sedation if required; provide airway support as needed.
Advanced Access Considerations
- Continue to use implanted subcutaneous ports if accessed and no infection signs are present.
- If doubts arise, switch to obtaining intraosseous access if necessary.
- Maintain aseptic technique during central line access and ensure proper sanitization of injection caps.
Blood Administration Protocol
- Blood transfusion crucial for severely ill/injured patients; ideally initiated at transferring facility.
- Candidates include adults with acute blood loss, unstable after 2 liters of Normal Saline, or with SBP < 90 mmHg.
- Assess complete vitals, skin condition, lung sounds, IV site, and transfusion history before administration.
- Confirm patient information with at least two healthcare providers before blood product initiation.
- Administer blood products within 4 hours after removal from designated temperature.
Blood Administration Procedures
- Start infusion slowly and monitor for reactions; reactions require immediate cessation of transfusion.
- Use appropriate equipment including pressure bags, leukocyte reduction filters, and normal saline.
- Document detailed transfusion information including time, volume, and any reactions or vital signs post-administration.
Considerations for Allergic Reactions
- Administer Diphenhydramine for allergic reactions if noted.
- Use Furosemide for patients showing signs of CHF after each unit transfused.
- TXA Protocol considerations for patients with penetrating trauma and hypovolemic shock.
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Description
This quiz focuses on the Pain Control Protocol outlined in the Critical Care Manual for the Memorial EMS System. Understanding pain management is crucial for providing effective patient care and reducing anxiety and discomfort. Assessing the severity of pain is essential for administering appropriate relief measures.
