The state of Massachusetts just passed an emergency protocol change requiring all paramedic ambulances to carry non opioid pain management alternatives, including Ibuprofen PO, Acetaminophen PO and Ketorolac IV or IM. Acetaminophen IV is optional. The changes are to take place January 1, 2018.
Here is the dosing regime:
Acetaminophen 1000 mg IV or PO
Ibuprofen 600 mg PO
Ketorolac 15 mg IV or 30 mg IM
Acetaminophen 15 mg/kg IV or PO to max 1000 mg.
Ibuprofen 10 mg/kg PO to max 600 mg.
Ketorolac 0.5 mg/kg IV or IM to max 15 mg.
The Massachusetts protocol includes the following note:
All pain medications have contraindications-do not administer medications in
such circumstances. These contraindications include but are not limited to:
Ketorolac and ibuprofen are contraindicated in head injury, chest pain, abdominal pain,
or in any patient with potential for bleeding, ulcer, or renal injury; likely to need...
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