General Approach to All Patients

Pain Management - Adult

Basic Life Support

  • Assess baseline pain level (0-10 scale, 0 = No pain, 10 = Worst pain)

Advanced Life Support

Analgesic agents may be administered under standing orders for patients experiencing severe pain from any one of the following:

  • Isolated extremity injury:
    • Fractures/dislocations of the shoulder and upper extremity
    • Fractures/dislocations of the hip and lower extremity
    • Animal bites or envenomations to the extremities
  • Burn without airway, breathing, or circulatory compromise
  • Sickle cell crisis with pain that is typical for that patient’s disease
  • Dental pain
  • Severe back pain
  • Acute chest pain, in accordance with Chest Pain protocol
  • Kidney stone highly suspected, in accordance with Abdominal Pain protocol

Agents for pain control

  • Fentanyl (Sublimaze) 1 mcg/kg (maximum 50 mcg) slow IV; repeat once after 5 minutes as needed (maximum 100 mcg total dose) OR 100 mcg intranasal via MAD (divide dose equally between nostrils)
    • Contraindicated if systolic blood pressure < 90 mmHg
    • Preferentially use intranasal delivery via MAD for those where IV access may be difficult to obtain in a timely fashion (extremity burns/injuries) or not indicated for chief complaint (stable dental or back pain)
  • After each drug dosage administration:
    • Reassess the patient’s pain
    • Note adequacy of ventilation and perfusion
    • Assess vital signs
    • Monitor oxygen saturation & end-tidal C02