Question: Under the Adult Analgesia Medical Directive, it indicates that for Mild-Moderate Pain, Acetaminophen and Ibuprofen should be considered. If the pain is mild-severe pain than ketorolac should be considered. If a patient is reporting severe pain as a result of isolated hip or extremity trauma, and the MOI is consistent with severe pain, does this mean that only ketorolac should be considered, regardless of the patients ability to tolerate oral medications?
The way that I read this is that Acetaminophen and Ibuprofen would not be indicated if the pain is severe.
Great question. You are correct in identifying that Acetaminophen and Ibuprofen are indicated for mild to moderate pain, while Ketololac is the only medication listed for severe pain. However, when treating isolated extremity injuries, the conditions state that Ketorolac be restricted to those who are unable to tolerate oral medications. Therefore, regardless of subjective pain severity, we would recommend that in the setting of isolated hip or extremity trauma, ibuprofen and acetaminophen are preferred unless the patient cannot tolerate oral medications.