Download Frequently Asked Questions

Frequently Asked Questions
PCP: Adult Analgesia Medical Directive
What is the possibility of co-administering Acetaminophen and Ibuprofen?
Whenever possible it is recommended that the patient be considered for coadministration of these two (2) medications for a better effect of the patient's pain
management. They are both analgesics and the ibuprofen is also an antiinflammatory so it should also help with swelling and therefore their pain.
Why do we treat the recurrent renal colic with Ketorolac?
Ketorolac is one of the most effective medications in the treatment of renal colic. It
blocks the prostaglandin formation. The prostaglandin is a naturally occurring fatty
acid derivative that is in the tissues. It is believed that it sensitizes tissue to pain.
May I treat a patient with Acetaminophen, Ibuprofen and then Ketorolac?
No, Ketorolac and Ibuprofen are both NSAIDS and should NOT be co-administered.
Ketorolac is to be considered for the patient that is unable to tolerate oral
medications. It may be considered for the patient who will require surgery and
who should remain NPO (nothing by mouth).
Treating with Acetaminophen and Ketorolac is not a possible combination either.
The way to remember it could be "when you go tablets you stay with tablets when
you go injectables you stay with injectables".
Is a fractured clavicle considered extremity trauma?
Yes, we are considering clavicles as an extremity trauma.
Can I top up the dosage of the medication taken orally prior to EMS arrival?
No, this is not allowed under the medical directive. If the patient has received any
dose of Acetaminophen prior (up to 4 hours before) or Ibuprofen (up to 6 hours
before) it is a contraindication to give the patient the medication.
1
Frequently Asked Questions
PCP: Adult Analgesia Medical Directive
Can you elaborate on the statement "Acute Back Strain".
This is the sudden event whereby the patient has strained their back. You may also
consider the situation whereby the patient has a history of back problems and now
they are having an acute exacerbation of a chronic back problem.
Would you consider a patient who is NPO unable to tolerate oral medications?
You would consider a patient who is NPO as being unable to tolerate/take oral
medications.
Would you consider a potential surgical patient: NPO?
You might also consider someone with an extremity fracture who may require
surgery as a patient who should be NPO.
What medication can be considered for the patient in severe pain due to an
isolated hip or extremity trauma (that can tolerate oral medications)?
Ketorolac should be given to the isolated hip or extremity trauma; if they are in
severe pain. You would also consider these patients to be NPO if surgery is a
possibility. Acetaminophen / Ibuprofen are not an option because it is considered
for mild / moderate pain; these medications would not be effective if the patient
was in severe pain.
Does taking a daily dose of ASA (80 mg) count as anticoagulation therapy?
ASA is not considered an anticoagulation therapy medication.
If a patient has taken their daily 80mg of ASA in the past 6 hours would this
contraindicate them for Ketorolac and Ibuprofen?
No, it does not.
2
Frequently Asked Questions
PCP: Adult Analgesia Medical Directive
Are we allowed to consider pain medications for a musculoskeletal back strain or
an isolated extremity injury occurring as a result of an MVC?
The musculoskeletal back strain would not be appropriate due to the possibility of
other underlying injuries due to the mechanism of injury. The same could be said
about the isolated extremity injury unless you are certain there is no other
underlying injury. With all the care we render to our patients good clinical decision
making is required.
Can we treat the patient with multiple extremity trauma or bilateral hip trauma?
Yes, you could consider the pain medication for the multiple extremity trauma as
long as you are certain there are no other traumatic injuries (e.g. HI, pelvis, etc).
3