Keywords
Introduction
Discussion
Casualty in Mild-to-Moderate Pain
Combat Wound Medication Pack Medications
Melxoicam 15 mg (NDC 61442-0127-10) and Ibuprofen 800 mg (NDC 53746-0466-00) pricing. Available at: https://www.va.gov/oal/business/fss/pharmPrices.asp. Accessed February 24, 2017.
Casualty With Moderate-to-Severe Pain Without Hemodynamic or Pulmonary Instability
Fentanyl OTFC—Oral Transmucosal Fentanyl Citrate
Mechanism of Action/Pharmacodynamics
Place the 800 µg OTFC lozenge between the cheek and gum. |
DO NOT CHEW the lozenge - efficacy is reduced if it is chewed. |
Tape the stick of the lozenge to a finger or rubber band it to the casualty’s body armor to cause removal from the mouth in case of somnolence. |
If severe pain persists after 15 min, add a second OTFC lozenge to the opposite cheek. |
Consider ondansetron 4 mg oral dissolving tablet, IM, or IV as needed for nausea/emesis. |
Monitor for respiratory depression. |
Remove weapons (eg, firearms, knives, etc.) from any casualty given OTFC. |
Casualty in Moderate-to-Severe Pain with Hemodynamic or Respiratory Compromise or Judged to be at Risk of Either Condition
Thomas A, Wiget U, Rammlmair G. Treatment of pain on the field. Available at: http://www.alpine-rescue.org/ikar-cisa/documents/2007/RECM0010E.pdf. Accessed March 30, 2017.
Ketamine
Ketamine Contraindications
Ketamine Use in Head Injury
Ketamine Side Effects
Ketamine Effect on Ocular Pressure
Ketamine Dosing: Low Dose/Analgesic Dose/Subdissociative Dose
Give initial 20 mg if IV or IO. |
Repeat q20 min as required. |
Give initial 50 mg if IM. |
Repeat q30 min as required. |
Can also give IN if nasal atomizer available. |
Give initial 50 mg if IN. |
Repeat q30 min as required. |
Give IV over 30 to 60 seconds to avoid rare apnea. |
Onset is in 1 min if IV, 5 min if IM or IN. |
Remove weapons from any casualty given ketamine. |
Ketamine Dosing: High Dose/Dissociative Dose/Sedation Dose
Pain Control Medications BEYOND the Triple-Option Analgesia APPROACH: Intravenous Morphine
Training, Legal, and Cost Considerations for Wilderness Use
Thomas A, Wiget U, Rammlmair G. Treatment of pain on the field. Available at: http://www.alpine-rescue.org/ikar-cisa/documents/2007/RECM0010E.pdf. Accessed March 30, 2017.
Conclusions
References
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Article info
Footnotes
☆Presented at the Tactical Combat Casualty Care: Transitioning Battlefield Lessons Learned to Other Austere Environments Preconference to the Seventh World Congress of Mountain & Wilderness Medicine, Telluride, Colorado, July 30–31, 2016.