If a patient is in moderate to severe pain and SBP is less than 90 mmHg with no Narcan available, what should you administer?

In situations where a patient is experiencing moderate to severe pain and has a systolic blood pressure (SBP) of less than 90 mmHg, the choice of analgesic must consider both the effectiveness of pain management and the hemodynamic stability of the patient. Administering ketamine intranasally (IN) in this scenario serves multiple purposes.

Ketamine is a dissociative anesthetic that provides analgesia and sedation without significantly impacting blood pressure. In fact, it can often maintain or even stimulate cardiovascular stability, making it a preferable option when traditional opioids like fentanyl or morphine could further lower blood pressure or cause respiratory depression. Additionally, the intranasal route is effective for rapid absorption, which is beneficial in acute pain scenarios.

Fentanyl delivered buccally could be problematic in this instance, as it is opioid-based and may not be appropriate given the risk of hypotension. Morphine could also exacerbate the patient's low blood pressure and may require closer monitoring and titration. Acetaminophen, while useful for mild pain relief, is insufficient for moderate to severe pain relief and would not help in addressing the urgent need for effective analgesia in this context.

Therefore, administering ketamine allows the practitioner to address both