1. Medication In-Service:
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
Remove ketorolac (Toradol) from the SEM Drug Box

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

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

26. How to administer ketorolac
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
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

30. Medication In-Service:
Michigan EMS
Medication In-Service:
Ketorolac (Toradol)
Thank you for utilizing this Instructor Resource Guide in preparation for delivery of continuing education. This course is intended to serve as an introduction and overview of the new protocols. LSAs will need to facilitate further education to ensure their providers are informed of changes to specific protocols.
Questions???