Toradol/ketorolac for major trauma pts

ANnot4me · Sep 29, 2010

I haven't used that drug for years and the first thing I thought of was "No, because of the risk of bleeding." I did not even process the question any further. Was it ordered? Perhaps there is a rationale we don't understand? And just maybe somebody was momentarily without their faculties. Happens to us all.

SummitRN, BSN, RN · Sep 29, 2010

Wait, so what was the crit? And the injuries? And... a lot more info on the pt?

manncer · Sep 29, 2010

I would see it as a complete no-no. The patient may be bleeding internally. NSAIDS are a dangerous choice in this case.

PAERRN20 · Sep 29, 2010

No...for the bleeding risk, but also if I fall 25 feet give me the good stuff, not Toradol!

grandmawrinkle · Sep 29, 2010

Depends. I definitely wouldn't ask for it first line....I am assuming they tried narcotics first.

I don't usually worry about kidney function too much with toradol with young, generally healthy patients that are only going to get it for a limited period of time.

I'm not sure why the docs would have ordered it if it was absolutely contraindicated. Every drug has a risk/benefit ratio. Typically physicians put a lot of thought into using toradol and they probably thought that was the best option.

tyvin, BSN, RN · Sep 29, 2010

That would be a no. The doc is probably one of those that doesn't like to use narcs so goes for the high-end NSAIDs like Toradol. So what happened? In this case I would've brought the matter to the docs attention and had an alternative in mind.

There could be many factors that influenced the doc to order that way such as perhaps the patient is allergic or a substance abuser and requested no narcs or the doc could be shy about using narcs. Find out so you can get to know the docs personality/preferances and working together gets easier.

Altra, BSN, RN · Sep 29, 2010

I'm assuming that this was the pain relief ordered on initital exam, before radiology.

Was the patient's c-spine cleared at the time the Toradol was ordered? If not, maybe there was a concern about narcotics and masking possible neuro s/s.

But I can't imagine that this patient didn't get scanned - head, neck, chest, & abdomen/pelvis - pretty quickly. As soon as those scans are read, then further decisions regarding what analgesics to give next can be made.

nursynurseRN · Sep 29, 2010

Sooo, here's the question....
do/would you give toradol to a trauma pt. Fall >25 ft thru many obstacles (wood ect) with +3 blood & +3 protein in urine and decreased output ? VS WNL. A&O x4. Pain mid thoracic.
FYI, I didn't b/c of potential for increased bleeding, impaired kidney function, potential for surgery ect.

Most of our trauma patients get toradol, The trauma doc's use to reduce inflammation. It is an NSAID like a mega dose of motrin and it make sense it may casue bleeding, but I have seen the DOc's order this all the time for years. They don't do it right away ususally a few days post trauma.....

rn/writer, RN · Sep 29, 2010

After injuries from a fall > 25 ft, you'd certainly want to look at platelet count.

back2bRN · Sep 29, 2010

Thanks for the replies, it was prior to DI(which subsequently all our computer/server systems had a failure arghhh)

First, yes it was ordered,I ensured the MD knew all the U/A results, second yes I offered alt of MS, declined by MD d/t "I don't want him to be drowsy" yet in anticipation of transfer I asked for antiemetic and got an order for gravol?!? Usual s/e drowsiness!!

My other team member was from Trauma/surgery unit and she questioned the order as well.

Initial CBC WNL except WBC which was double normal (underlying dental infection, teeth were awful-I wondered about meth mouth)Hgb,Hct platelets were fine,not even near lower levels of normal, nor indicating dehydration.I don't know what subsequent ones were though.

Doc was made aware of urine issues and in fact didn't even want to have a cath put in. This pt was sent to the tertiary care center, ASAP

BTW there is SIGNIFICANT hx b/w this MD & I, she loves her toradol.....ordered it for a first &worst H/A in a pt on Plavix....again I didn't give it and although I find it to be very effective, it can have some significant effects. Wanted to reduce a shoulder that wasn't out in a pt with bone mets, wouldn't call the rad on that one.(i went around her, the xray tech called the rad oncall to get them to read the xray) My days working with her involve me trying not to antagonize the situation by picking the hill to die on!!!

rwright15 · Oct 18, 2010

WBC would be high after a trauma without the presence of infection (FYI). Most md's do not want a pt with a head injury to receive narcotics. It's just simply unsafe to give right away. I would think the initial dose of Toradol would be fine. It's the multi doses that I would question.