Category: Adult Analgesia

Ketorolac in severe pain

Submission ID: 126



In Adult Analgesia Medical Directive, administration of Ibuprofen and acetaminophen is preferred to Ketorolac except where the patient is unable to tolerate oral medication. Can you clarify if, when the patient is in severe pain, a paramedic can go right away and administer ketorolac (as Ibuprofen and Acetaminophen is only indicated for Mild to Moderate pain) or if we still give Ibuprofen and acetaminophen for severe pain, even if not in the indications, because the clinical considerations mention that it is preferred over ketorolac in isolated hip or extremity trauma.



While the medical directive states that “In patients with isolated hip or extremity trauma, ibuprophen and acetaminophen is preferred to ketorolac”, they are only indicated for mild to moderate pain. If the patient is in severe pain, then ketorolac may be administered, even if the patient can tolerate oral medications.


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