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Analgesia

Opioids for Mild/Moderate Pain

With the removal of severe pain as a requirement for treatment with opiates, and the conventions still stating that we are to provide the prescribed treatments unless there is a clinical rational not to, is the expectation that we are to treat mild…

Opiates and Ketamine for patients with OUD

We just transported a 38F with abdominal pain x2 days. Known recreational narcotic user. Has been on methadone for a lengthy amount of time - possibly years. Mom on scene came out and without emotion, told us she asked her daughter to put some pant…

Methoxyflurane & Temperature

In regards to the methoxyflurane study, in the protocol itself there is no stipulation for a specific cutoff regarding an increase in temperature. At which point (what tympanic temperature) should the Penthrox be discontinued?

Ketamine for Analgesia Dosing

IV dose, 17 years and 364 days old, maxes out at 40kg (10mg) (... or just 17 years old so I'm not being pedantic.) IV dose, 18 years old, is now 20mg. (2x dose) IN dose 17 years and 364 days old maxes out at 30kg (30mg) (... or just 17 years old s…

Methoxyflurane Use and Pregnancy

With the current Methoxyflurane trial in some jurisdictions, there seems to be a lack of information regarding safety of paramedics with regarding to inhaling patient's exhaled medication. Particularly with regards to pregnant paramedics, as pregnan…

Pain management in pregnant patients

When discussing pain management options with a pregnant female (approx 6-8 weeks gestation), the pt denied offer of narcotics due to fear of harm to her fetus. I empathised with her concern, and celebrate her strength, but not successful in helping…

Acetaminophen use in pregnant patients

I treated a patient with 1,000 mg of Acetaminphen P.O.. The patient had a possible fx. wrist. The patient is 2 months pregnant. On arrival at the ER, the RN that I gave a report to, questioned my use of Acetaminophen with a pregnant patient. When I…

Morphine Allergy

Can a patient who has an allergy to morphine receive fentanyl? Also, I have seen several patients allergic to morphine, have hydromorphone or Dilaudid on prescription, why is this?

TOC to PCP after narcotics

I am writing to request clarification regarding the protocol or best practice for ACP/PRU/Supts administering narcotics for pain management and leaving the patient under the care of a primary care paramedic on the scene for autonomous transport?

May acetaminophen and/or ibuprofen be administered to patients with headaches

Can acetaminophen and ibuprofen be given to patients to treat headaches, assuming they meet the other aspects of the directives? I’ve been told by colleagues that even PCP scope analgesia used specifically for headaches isn’t allowed, but I never i…

Opioid analgesia in the hypotensive patient

If you have a patient who is complaining of severe pain and is initially hypotensive requiring a fluid bolus. After the fluid bolus they are now normotensive-are we then able to treat them with morphine or fentanyl as now they meet the directive? or…

What must be considered in coadministration of morphine and fentanyl?

Under analgesia directive, It sates, "Fentanyl should not be used in combination with morphine unless authorized by BHP." Is this specific to co-administration? For example, we treated a fracture with fentanyl on scene to splint and extricate the pa…

Thrombocytopenia and Ketorolac

Why is thrombocytopenia not a contraindication for Ketorolac administration but being on a blood thinner is?

Should opioid analgesia be administered to a patient with opioid use disorder?

Opioid pain control for recovering addicts. What is the RPPEO stance on this? It could be severely detrimental to introduce opioids to someone currently in recovery of opioid addiction. It is not contraindicated. I often don’t bring up the possibil…

RPPEO Standards - Renal Impairment (Ketorolac)

In respects to the Ketorolac protocol, one of the contraindications is renal impairment. What is the definition, as per the RPPEO standards, of renal impairment? Is it a known pre existing disease process of the renal system or would it also include…

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