Pain Management


  • Systolic BP >100 mmHg, no head injury or altered level of consciousness
  • Fentanyl 25-100mcg IV/IM/IN/IO or Morphine Sulfate 1-5mg IV/IM/IO
  • Repeat once if pain is not relieved in 5 min and BP >100 systolic
  • Monitor BP, respirations, and mental status
  • Narcan 0.4-2.0mg IV/IM/IN/IO if patient experiences respiratory depression

Obstetrical (Child Birth)


  • >24 weeks = viable baby
  • O2 & IV if time permits
  • Assist with delivery if head is presenting
  • Elevate hips and transport if delivery is malpresentation
  • Prolapsed cord = relieve pressure on cord, elevate hips, keep cord moist, transport
  • Cord around neck = gently slip over head; if too tight, apply 2 clamps 1 inch apart and cut between them
  • Breech = support and deliver baby if delivery is imminent
  • Notify receiving hospital

Nausea / Vomiting


  • Contraindicated for allergies to 5-HT(3) receptors such as Kytril and Aloxi
  • Administer ondansetron (Zofran) IV/IO 4mg slow IV push,


    Administer ondansetron (Zofran) IM/PO 4mg (PO=solutab)

  • Repeat 4mg IV/IO dose in 5 minutes if symptoms have not resolved