FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Moderate–severe pain (4–10) as an adjunct/alternative to opioid analgesia under PR-075.
Contraindications & local exclusions
- OCEMS PR-075 excludes age below 2 or above 65, suspected cardiac pain, NSAID allergy, active peptic ulcer/recent GI bleed or perforation (under 3 months), designated trauma/high hemorrhage risk, concurrent NSAIDs or anticoagulants (the policy allows low-dose aspirin), recent major surgery (under 6 weeks) or scheduled major surgery, renal disease/transplant, pregnancy/suspected pregnancy, or breastfeeding.
- General injection labeling: concurrent aspirin or another NSAID is contraindicated because of cumulative serious NSAID adverse-event risk. This differs from the low-dose-aspirin exception printed in OCEMS PR-075; the local exception does not establish universal product-label compatibility.
Precautions
- Clarify the aspirin-specific difference through medical direction rather than inferring compatibility. The matched IV/IM injection label has additional surgery, bleeding, renal and administration-route restrictions, and its pediatric labeling differs from OCEMS use. Local pediatric/IO authorization is not established by product labeling. Monitor response and bleeding risk.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- Do not give above age 65, for suspected cardiac pain, NSAID hypersensitivity, renal disease/transplant, pregnancy/suspected pregnancy, or breastfeeding.
- Exclude active ulcer disease, GI bleeding/perforation within 3 months, trauma-center designation, active/high-risk hemorrhage or coagulopathy, recent major surgery within 6 weeks or planned major surgery, and concurrent NSAID/anticoagulant use. PR-075 makes an exception for low-dose aspirin.
Use in OCEMS
- For moderate–severe pain (4–10), as an alternative or adjunct to an opioid when PR-075 criteria are met.
- Examples include opioid intolerance/refusal, moderate pain where opioids may not be appropriate, inability to obtain IV access, or additional analgesia after fentanyl.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| Eligible adults | 15 mg IV/IO/IM once. IV is preferred when a line is present. |
Pediatric
- For eligible children age 2 and older: 0.25 mg/kg IV/IO/IM once, maximum 15 mg.
- Age below 2 is a contraindication. Use measured weight in kilograms and record it.
Pediatric weight table — Pain — age 2 and older only
- PR-075 pediatric dose: 0.25 mg/kg IV/IO/IM once.
- Age 2 and older: 0.25 mg/kg IV/IO/IM once; maximum 15 mg. Children younger than 2 are excluded regardless of weight.
- Check all PR-075 exclusions, including renal disease, bleeding risk, designated trauma, recent GI bleeding, NSAID allergy/use, pregnancy, and breastfeeding. Weight alone does not establish eligibility.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO/IM once | Volume at 15 mg/mL |
|---|---|---|
| 3 kg | 0.75 mg | 0.05 mL |
| 4 kg | 1 mg | 0.067 mL |
| 5 kg | 1.25 mg | 0.083 mL |
| 6 kg | 1.5 mg | 0.1 mL |
| 8 kg | 2 mg | 0.133 mL |
| 10 kg | 2.5 mg | 0.167 mL |
| 12 kg | 3 mg | 0.2 mL |
| 15 kg | 3.75 mg | 0.25 mL |
| 20 kg | 5 mg | 0.333 mL |
| 25 kg | 6.25 mg | 0.417 mL |
| 30 kg | 7.5 mg | 0.5 mL |
| 35 kg | 8.75 mg | 0.583 mL |
| 40 kg | 10 mg | 0.667 mL |
| 45 kg | 11.25 mg | 0.75 mL |
| 50 kg | 12.5 mg | 0.833 mL |
| 60 kg | 15 mg | 1 mL |
Preparation & reassessment
- The inventory concentration is 15 mg/mL. Verify the ordered milligrams and volume; the dose is not 15 mg/kg.
- Document indication, exclusion screening, baseline pain, pediatric weight, response, and any adverse reaction.
UNDERSTAND THE CARE
Why an NSAID choice still requires a complete risk screen
The local procedure restricts ketorolac by patient characteristics and clinical circumstances. Its non-opioid classification does not remove the need to assess renal, bleeding, pregnancy and injury-related exclusions. A dose shown for a weight or age is not proof that the patient is eligible.
Applying the guidance
Use the actual condition and procedure to establish the indication, then the correct age/weight instructions to prepare the dose. Check medications already taken and keep the drug’s concentration and intended volume distinct. Reassess pain and the underlying injury or illness rather than interpreting analgesia as resolution of the cause.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Indication
- Pain condition within local scope.
- Risk screen
- Age, renal function, bleeding and pregnancy.
- Preparation
- Eligible age/weight regimen and product.
- Reassessment
- Pain and the underlying clinical problem.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Screen eligibility before opening the dose table
The most useful first check is whether the patient qualifies, not whether a weight-based volume can be calculated. PR-075 places several exclusions on otherwise familiar pain presentations. A normal-looking dose calculation does not address renal history, hemorrhage risk, pregnancy, recent surgery or medication interactions.
For example, a patient with substantial pain and a readily available IV may still be excluded by the injury pattern or medical history. State the indication and document the relevant negative screening findings before selecting the regimen. A patient who has already received an opioid still needs the complete ketorolac screen; “additional analgesia” is an indication context, not an exemption from contraindications.
Keep the local low-dose-aspirin wording separate from the product-label warning already described above, and clarify that difference through medical direction. After treatment, reassess pain and the underlying clinical condition. A reduction in pain does not retrospectively establish that the original injury was minor or that bleeding risk has resolved.
Source: Ketorolac for Patient Analgesia.