This is a very unlikely scenario, but I wondered if Toradol could replace Ibuprophen for the patient experiencing pain. In the unlikely event that a patient is able to take Tylenol and once administered pt refuses Ibuprophen due to nausea (post tylenol administration) could Toradol be used? It would be rare as the contraindications are the same for both nsaids aside from nausea and unable to tolerate oral med administration for Ibuprophen. Could pt preference come into play, a patient in severe pain states “I have had toradol in the past and it works really well for me” assuming all other conditions are met could they receive toradol in addition to tylenol to compliment the nsaid?

I have a question regarding the PCP analgesia medical directive. If a patient has been using topical gels for pain relief (such as voltaren gel containing diclofenac), is ibuprofen/ketorolac still contraindicated if it has been used within the last 6 hours?

In the Toradol protocol it simply uses term “current/active bleed” as a contraindication, the companion document provides little clarification as to how this applies to trauma pts as trauma was removed as a contraindication. Would trauma with high index of suspicion for internal bleeding (MVC, Motorcycle accident, fall from height) be a contraindication? Would multisystem trauma pts? Or would the better course of action be to treat their pain? Thanks!