Toradol

torodol

I rank Toradol 27 out of the 33 drugs I carry.

First, let me say, I am a huge proponent of pain management. As a member of the committee that writes our regional guidelines, I fought for an alternative to morphine for those patients in pain who were allergic to mophine. The first result was Toradol. Later, we secured Fentanyl. The Fentanyl, however, hasn’t yet shown up in our controlled substances kits, although I am told it is coming. As with any change to controlled substances, each change requires DEA approval and must work its way administratively through both hospital, pharmacy, and DEA heirarchies and back and forth until the policy is set in stone. I know this because it took a year to get Fentanyl in the kits of one of the paramedic services I oversee. When Fentanyl arrives in my kit, it will likely be ranked quite high on my list and push Toradol down even further, possibly to the point where we will have no need to carry it.

Toradol requires on-line medical orders for us to use. And there are some doctors who will never let us use it. Their vieww is there are just too many possible side effects, particuarly in elderly patients to give the drug without having an ED doctor first examine the patient and do a set of labs. The patient may have some degree of renal failure or, if they are a candidate for surgery, Toradol can interfere with their clotting.

The ideal patient for Torodal is probably a thirty-five-and under-year-old otherwise healthy adult who is presenting with kidney stones. Yet on a number of times I have called for permission to use it for patients with apparent kidney stone flank pain, I have been denied and told to just use morphine. All told I think I have only gotten permission to use the drug 3 times. Only once did I use it for someone who was allergic to morphine — an older woman who had broken her shoulder. I called and got orders, gave the drug and it worked quite well. The other two times were for kidney stones and I gave the Toradol along with morphine, again with positive results. If I think a patient has kidney stones I will always call for Toradol even if I think there is a good chance they will turn me down. I don’t take it personnally.

***

Ketoraloc Tromethamine (Toradol)

Class: Non-steroidal Anti-inflamatory (NSAID)

Action: Analgesic, anti-inflammatory, and anti-pyretic via inhibition of prostaglandin synthesis

Indication: Moderate to severe pain, especially renal colic (kidney stones)

Contraindications:
Hypersensitivity to ketorolac, aspirin or other NSAIDS
Age <1 year old
History of peptic ulcer disease, gastrointestinal bleeding or perforation
Advanced renal impairment
Hypovolemia
Cerebrovascular bleeding
Any patient at high risk of bleeding
Late pregnancy, active labor or nursing mothers
Patients currently receiving aspirin or NSAIDs

Precautions: Patients ? 65 years of age or less than 50 kg
History of renal disease
Dehydration
Pregnancy class C

Side Effects:
Can cause peptic ulcers, gastrointestinal bleeding and/or perforation
May precipitate renal failure in patients w/ dehydration or renal impairment
Nausea (12%)
Dyspepsia (12%)
Headache (17%)
Drowsiness (6%)

Adult Dose:
Patients <65 years of age:
One dose of 30 mg Slow IV or Deep IM

Patients ? 65 years of age, renally impaired and/or less than 50 kg (110 lb)
of body weight:
One dose of 15 mg Slow IV or Deep IM

Pediatric Dose:
One dose of 0.5 mg/kg up to a maximum of 30 mg Slow IV or Deep IM

3 Comments

  • Greg Friese says:

    I am really enjoying this series and have just worked my way backwards from Versed this evening. Your statement “I don’t take it personally is a great reminder.”

  • i have a history of renal colic ,and i asure u when u are hitting the 10 scale , toradol does 0 for me and it does 0 for anyone,if u have not had a kidney stone,u will never understand,the pain could be a ten the a0 in 10 seconds so iof course the person thinks the toradol worked until ,the colic pain starts again.What infuriates me ,i have never abused any medication,so why do we have to suffer for all the drug abusers,u do not hand someone a smartie when they are in excruciating pain,in fact i hope every urologist has a good dose of a kidney stone,lmao and see if the smarties work.How dare they ,it is less than humane ,you are right i want the strongest drug they can give me ,to help this intolerable pain,how dare they think people with authentic pain are looking for a fix.id sue the bastards

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  • Comments
    Christy
    Paramedic Students
    Enjoyed reading this. I am an EMT-B who is in Paramedic school and I have been on the receiving end of working with a few medics who seemed to have forgotten that they were just like me once upon a time. And there are medics who I have cherished my time working with as they…
    2015-06-19 23:10:13
    karl
    Paramedic Students
    Thank you for your openness. I am a paramedic who works full time in a busy ER and rides with my volunteer squad in my hometown. It is a study in proficiency evaluation to observe the amount of respect and/or validity the receiving RN gives the EMT/paramedic who is giving her report on their pt.…
    2015-06-19 06:34:13
    Jim
    Paramedic Students
    I retired from EMS after 25 plus years. Although I was never a Paramedic, I was for the last few years an EMT-I. I remember the feelings that I had near the end of my road time. Tired and grumpy all the time from working 2 jobs and putting in usually 77 plus hours a…
    2015-06-19 03:53:22
    Michael
    Paramedic Students
    Good read. I appreciate the frankness of the author in relating his attitude towards his partners. I was a paramedic for seven years, and I found myself being the guy you described more than once. It's easy to forget that we were all new once I guess.
    2015-06-18 19:09:14
    Dennis Dudley
    Paramedic Students
    I did read the book, and it gave me more respect for paramedics than I once had. The book gave me an idea of all the training they have to go through. The book made me focus on being a better EMT-B. I will pick up the book and re-read it again every so often…
    2015-06-18 18:36:40

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