3-10 TRAUMA-PROLONGED EXTRICATION-PAIN

Purpose: To ensure that pain and nausea are appropriately addressed in the field to promote safe and comfortable extrication, management, and transport of the patient.  Under this guideline, there is recognition that the dissociative effects of Ketamine may be of greater benefit than the analgesic effects of opioids in order to maximize patient comfort and facilitate difficult manipulation of patients that will require prolonged and painful extrication from a trapped position.

Inclusion Criteria without prior Medical Control Authorization:

1. Severely mangled or trapped extremity / portion of body that will require prolonged or painful manipulation to free from a confined space.
2. Age greater than 6 and less than 75
3. Systolic BP > 100 mm Hg in an adult
4. No known allergies to medications being administered
5. No known exclusion criteria present

Inclusion Criteria that require Medical Control contact prior to medication administration:

1. Pregnancy
2. Age <6 or >75 (may require dosage adjustment)
3. Weight <85 lbs (may require dosage adjustment)
4. Systolic BP < 100mmHg
5. Altered Mental Status
6. Respiratory distress with potential for patient fatigue

Exclusion Criteria:

1. Known allergy to medication

Guidelines:

Paramedic - Perform/Confirm All Above Interventions

1. Obtain vital signs and allergies
2. Ask patient to rate pain on scale of 1 to 10
3. Establish an IV/IO of NS TKO
4. If prior pain/sedative medications HAVE NOT been administered, give KETAMINE 1mg/kg IV/IN/IO or 4mg/kg IM
5. If prior pain/sedative medications HAVE already been administered and 5 minutes have passed without desired effect, give KETAMINE 0.5mg/kg IV/IN/IO or 2mg/kg IM.
   1. If KETAMINE is administered and there are any signs of emergence phenomena, such as hallucinations, delirium, or increasing agitation, contact medical control for discussion of supplemental Versed.
6. Ondansetron (Zofran) 4 mg IV/IN/IO may be administered for control of patient nausea as needed with or without pain medication. Consult Medical Control for further doses of Zofran if sufficient relief is not obtained.
7. Reassess pain scale and vital signs including pulse oximetry every 5 minutes
8. If sufficient pain relief is not obtained within 5 minutes of giving the initial dose, Contact MEDICAL CONTROL for further orders.
9. Once the patient has been successfully extracted, follow the indicated Trauma Protocol, initiate transport, and Contact MEDICAL CONTROL for further orders.
10. Reassess vital signs, mental status, pain level and respiratory effort and if continued pain over 5, Contact MEDICAL CONTROL for any further dosages.