study EMS nursing

1. Michigan EMS
Medication In-Service:
Ketorolac (Toradol)

2. Course Objectives
• Identify the location of ketorolac (Toradol) in the SEM
Drug Box, as well as how it may be packaged.
• Describe the pharmacokinetics and pharmacodynamics of
ketorolac (Toradol).
• List the indications and contraindications of ketorolac
(Toradol).
• Describe how to administer ketorolac (Toradol), as well as
list the applicable medication concentration, route and
dose(s) per the applicable protocols.

3. Introduction
Purpose
– As of June 1, 2018, the following
medications were added to the Southeast
Michigan Regional Medication Boxes
(SEM Drug Box):
• Ketamine
• Ketorolac (Toradol)
• Push Dose Epinephrine
• Ondansetron (Zofran) ODT

4. Introduction
Purpose
– This CE will focus on:
• Ketorolac (Toradol)

5. Location in the SEM Drug Box
One 15mg vial will be stocked in the drug box

6. Location in the SEM Drug Box
Ketorolac will not be supplied in the A-Pack

7. Pharmacokinetics and Pharmacodynamics
Class of medication
– Nonsteroidal anti-inflammatory drug
(NSAID)
• Used for treating inflammation and pain
• Other NSAIDs include:
– Ibuprofen, naproxen and aspirin
– Toradol is more effective than other NSAIDs in
reducing mild to moderate pain from both
inflammatory and non-inflammatory causes

8. Pharmacokinetics and Pharmacodynamics
Mechanism of action
– Anti-inflammatory medication
– Ideal medication for mild to moderate
acute pain resulting from an injury

9. Pharmacokinetics and Pharmacodynamics
Route of administration
– IV: Ensure the medication is delivered slowly over
at least 15 seconds
– IM: Provide the injection slowly

10. Pharmacokinetics and Pharmacodynamics
Onset and duration of action
– Patients will experience pain relief
approximately 30 minutes after
administration
• Effect consistently lasts between 4-6 hours
• Maximum effect is 1-2 hours after
administration
• The sooner that ketorolac (Toradol) is
administered, the sooner the patient’s pain
will be relieved

11. Pharmacokinetics and Pharmacodynamics
Half-life
– Approximately 5 hours in the adult patient
– Half-life increases in the elderly and those
with renal impairments

12. Pharmacokinetics and Pharmacodynamics
Side effects
– Side effects of ketorolac are more
commonly found with larger dosages
– Keep in mind that 15mg is a small dose

13. Pharmacokinetics and Pharmacodynamics
Side effects
– Abdominal pain
– Nausea
– Indigestion
– Headache

14. Pharmacokinetics and Pharmacodynamics
Side effects
– Less common side effects
• GI bleeding and ulcers
• Susceptible to anemia and increased
bleeding time
• The above are likely to occur when higher
doses are taken for several days

15. Indications
Ketorolac (Toradol) SHOULD be administered
in the following situations:
– Patients presenting with mild to moderate pain is rated
a 1-4 on the Wong Pain Scale

16. Indications
Ketorolac (Toradol) SHOULD be administered
in the following situations:
– Often used in treating pain associated with kidney
stone pain
– May be considered a first line medication for known or
suspected kidney stone pain independent of the pain
scale score

17. Contraindications
Ketorolac (Toradol) should NOT be
administered in the following situations:
– Allergy to ketorolac or other NSAIDS such as aspirin
or ibuprofen

18. Contraindications
Ketorolac (Toradol) should NOT be
administered in the following situations:
– Pregnancy, active labor or women who are
breastfeeding

19. Contraindications
Ketorolac (Toradol) should NOT be
administered in the following situations:
– Renal impairment

20. Contraindications
Ketorolac (Toradol) should NOT be
administered in the following situations:
– Bleeding or high risk of bleeding
• Patient with a history of GI bleeding, ulcers, or
perforation should not receive ketorolac

21. Contraindications
Ketorolac (Toradol) should NOT be
administered in the following situations:
– A patient already receiving NSAIDs such as aspirin
or ibuprofen should not receive ketorolac (Toradol)

22. Applicable protocols
• Pain Management (procedure section)
– Ketorolac (Toradol)
• Adult 15mg IM/IV
• Pediatric 1mg/kg IM/IV
– Max dose 15mg

23. How to administer ketorolac
1. Remove ketorolac (Toradol) from the SEM
Drug Box

24. How to administer ketorolac
2. Verify the correct medication and dosage
– Concentration: 15mg in 1mL
– Dose:
• Adult: 15mg
• Pediatric: 1mg/kg (max 15mg)

25. How to administer ketorolac
3. Draw the medication from the vial
– You’ll need:
• Syringe
• Needle
• Alcohol prep

26. How to administer ketorolac
4. Administer the medication
– IV or IM
• IV: Ensure the medication is delivered slowly
over at least 15 seconds
• IM: Provide the injection slowly
IV IM

27. How to administer ketorolac
5. Monitor the patient
– Monitor the patient for the desired effect
– The medication will take effect within 30
minutes
– Reassess the patient’s pain on the Wong
Pain Scale

28. Medication Section 9
• Every medication available in the SEM
Drug Box and A-Pack is now detailed in
“Section 9 Medications” of the State of
Michigan EMS Protocols
– Click here to access to digital document

29. Medication Section 9
• Ketorolac (Toradol) 9-30
– Applicable Protocols
– Indications
– Contraindications
– Dosing:
• Adult
• Pediatrics
– Expected Effects
– Side Effects
Michigan
MEDICATION SECTION
KETORALAC (TORADOL ®)
Initial Date: 10/25/2017
Revised Date: Section 9-30
MCA Name: Click here to enter text.
MCA Board Approval Date: Click here to enter text. Page 1 of 1
MCA Implementation Date: Click here to enter text.
Protocol Source/References: Click here to enter text.
Ketoralac (Toradol ®)
Protocols:
1. Pain Management (per MCA selection)
Indications:
1. Mild to moderate pain
Contraindications:
1. Allergies to NSAIDs
2. Active labor or women who are breastfeeding
3. Renal impairment
4. Bleeding or high risk of bleeding
5. Pregnancy
Dosing:
1. Adults – 15 mg IM/IV
2. Pediatrics – 1 mg/kg IM/IV (max dose 15 mg)
Expected effects:
1. Pain Relief
Side effects:
1. Nausea/vomiting
2. Bloating

30. Questions???
Michigan EMS
Medication In-Service:
Ketorolac (Toradol)