SDN Members don't see this ad. About the ads. one of the things that always frustrated me as a medic was the inability to achieve adequate pain control for the patient in acute distress. in the systems i have worked in, prehospital protocols typically max out at 10mg morphine / 150mcg fentanyl with the option to request more if necessary (which many medics do not take advantage of because calling the hospital could prove time consuming). quite frequently i've seen these doses only mildly effective for severe pain (esp in pelvic fx, femur fx, sickle cell, etc). i am wondering if anyone has seen such as repeating doses of opioids without a hard maximum or perhaps using something like ketamine?