January 26, 2023

EMS Update 2018

Treating pain is part of ems care it’s important that we treat the underlying cause of the pain during ems patient encounters but treating pain as an individual symptom is important as well treatments include non-pharmacological techniques as well as pharmacological pain management comfortable positioning splinting of fractures or suspected fractures the application

Of ice elevation and compression of musculoskeletal injuries particularly joint injuries are all forms of a non pharmacological pain management pharmacological treatment of pain and ems whether or not associated with trauma has historically been limited to narcotic analgesics santa clara county ems is introducing intravenous acetaminophen as a non-narcotic

Alternative to the treatment of pain intravenous acetaminophen can be used to treat mild to moderate pain the medication may be used for patients weighing greater than 50 kilograms patients will receive 1000 milligrams of the medication administered from a 100 milliliter vial infused through iv over 15 minutes there are important contraindications to consider

Prior to the administration of acetaminophen known allergies to acetaminophen severe active liver disease or prior dosing of 3,000 milligrams of acetaminophen within the previous 24 hours iv or i m morphine will remain as the pharmacological treatment of pain for pediatric patients as well as patients weighing less than 50 kilograms police reference the santa

Clara county protocols for morphine dosing guidelines to determine if iv acetaminophen should be used the protocol provides the following guidance using the pain scale of one to ten if the patient expresses pain of a seven or greater or the patient weighs less than fifty kilograms use morphine via i am or iv if the patient expresses pain of less than a seven and

The patient is greater than fifty kilograms use iv acetaminophen it is also important to consider the contraindications for iv acetaminophen when determining the appropriate pharmacological treatment iv you see diminution is supplied in a 1,000 milligram 100 milliliter glass vial using an aseptic technique open the cap to the vial clean the port with an alcohol

Wipe and insert the macro drip iv administration set ensure the side port vent cap is opened administer the 1000 milligram dose over approximately 15 minutes the drip rate should be 60 drops per minute here is a short video from santa clara county ambulance demonstrating the setup for administration of iv acetaminophen the iv cinnamon ofin that we’re carrying it

Comes in a glass vial this means that you will need to have a vented iv tubing if we should here and an alcohol probe the trade name is affirmative acetaminophen injection as you can see the concentration is 1,000 milligrams in 100 milliliters there’s a plastic tab that comes down that you can use to hang the vial once you spiked it in case you weren’t familiar

This red tab here is the vent vent port for your drip set make sure that is open when you’re spiking the vial as with spiking any iv drip set take off your plastic tab we’re going to use a septic technique get your alcohol prep and make sure to clean the port now make sure that your vent is open and insert the drip set into the vial when possible keep the drip

Chamber about one-third full and we’re going to be administering this particular medication sixty drips per minute so that equals about one drop per second this in particular medication needs to be administered over 15 minutes so make sure that you’re monitoring the vial and it’s not going faster than intended once the medications beginning to be close to that

The finishing the completion of the vial make sure that you’re not make sure that you’re monitoring it so that you don’t administer any air into the into the line and also this particular medications can be administered iv piggyback or straight into the iv saline lock part of the strategy in deploying iv acetaminophen is to reduce the use of morphine enough to

More effectively manage the ongoing and variable manufacturing shortages the system has experienced the santa clara county ems iv acetaminophen clinical protocol is being published as a temporary freestanding clinical protocol pending field clinical experience with a focus in mild to moderate pain management as well as field operational practicality should iv

Acetaminophen be clinically and operationally favorable it will be integrated into the existing pain management protocols stocking of iv acetaminophen will initially be optional als inventory but one to two doses per als unit is recommended all santa clara county ems policies and protocols may be found on the ems agency’s web site at wwe ms agency org for any

Questions pertaining to iv acetaminophen please email us at ems agency at ems sec gun org

Transcribed from video
Intravenous Acetaminophen for Acute Pain By emssccgov