The contraindications for opioids, including fentanyl, are hypovolemic shock, respiratory distress, unconsciousness, or severe head injury.
In the TFC setting, the medications that are potentially delivered intranasally include: ketamine and naloxone
Unlike the other NSAID medications that inhibit platelet function and can lead to increased bleeding risk, meloxicam is a preferential COX-2 inhibitor that spares platelet function so it does not interfere with hemostasis.
If the casualty is in moderate to severe pain, and the casualty is in shock, or at risk of shock or pulmonary compromise, ketamine is the agent of choice.
The three potential sites are the deltoid, the thigh, and the buttock.