Category: Adult Analgesia

If a patient's pain is severe can we still give acetaminophen and ibuprofen?

Question:

With regards to the adult analgesia medical directive, it states under the "Indications" heading that:

  • "Mild – Moderate Pain (Acetaminophen/Ibuprofen) OR
  • Mild – Severe Pain (Ketorolac)"
  • Under the "Conditions" heading for ketorolac it states,
  • "Ketorolac
  • AGE: ≥18 years
  • LOA: Unaltered
  • HR: N/A
  • RR: N/A
  • SBP: Normotension
Other: For isolated hip or extremity trauma, restricted to those who are unable to tolerate oral medications

In a case where a patient has a hip or extremity trauma and is complaining of "Severe" (i.e. 8+/10) pain but is able to tolerate oral medications, do the "Conditions" supersede the "Indications"?
In other words, because the patient has severe pain, which is outside of the "indication" parameters for acetaminophen and ibuprofen (as they are for mild to moderate pain), would ketorolac be appropriate? Or are acetaminophen and ibuprofen more appropriate because the patient can tolerate oral medications despite his/her pain being "severe". The above assumes, of course, that the patient meets all other indications, conditions, and contraindications.

Answer:

In the clinical considerations from the ALS PCS v3.3. (see second bullet) It recommends you go with the oral meds (if the patient can tolerate oral meds) over ketorolac in those specific injuries despite the severity of the pain.

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