A0501-1: Pain Relief Flashcards
What is the CPG suggestion regarding:
When should Fentanyl be chosen over Morphine?
A0501-1 - Pain Relief
- C/I to Morphine
- Short duractiton of action desirable (eg dislocations)
- Hypotension
- Nausea and/or vomiting
- Severe headache
Where the IM route is req & Morphine is C/I, IM Fent may be used
What is the CPG suggestion regarding:
How much additional Ketamine should be drawn to account for atomiser dead space?
A0501-1 - Pain Relief
0.1mL
What is the CPG suggestion regarding:
What is the optimal absoption volume for IN medications?
A0501-1 - Pain Relief
0.3 - 0.5mL
What is the CPG suggestion regarding:
Emergence reactions in the setting of Ketamine
A0501-1 - Pain Relief
- Hallucinations or other behaviour disturbance are less common in low doses for analgesia
- Often transient and minimised by administering IV doses slowly (eg over 1-2 min) & reassurance (esp. in elderly/frail)
- Pts w/poorly controlled psych conditions (eg schizophrenia) may find some of the adverse effects of ketamine distressing.
- Midazolam 0.5-1mg IV (ALS Consult only) for significant or persistent reactions
What is the CPG suggestion regarding:
Ketamine infusion preparation
A0501-1 - Pain Relief
50mg up to 5mL w/Normal Saline to make 1mg/1mL solution
Recommended infusion rate of 0.1-0.3 mg/kg/hr
What is the CPG suggestion regarding:
First line analgesia for moderate pain
A0501-1 - Pain Relief
IV Access Available:
- IV Morphine/Fentanyl
IV Access Unavailable:
- IN Fentanyl (preferred in frail/elderly/adolescent)
- IN Ketamine
All pts receive oral paracetamol unless C/I
What is the CPG suggestion regarding:
Second line analgesia for moderate pain
A0501-1 - Pain Relief
Other options unsuccessful / unavailable / C/I
- IN Ketamine (if min response to opioids)
- IM Morphine (if opioid not already administered)
What is the CPG suggestion regarding:
Ketamine for cardiac chest pain
A0501-1 - Pain Relief
Contra-indicated
What is the CPG suggestion regarding:
First line analgesia for severe pain
A0501-1 - Pain Relief
IV Access Available
- IV Morphine / IV Fentanyl
and
- IN Ketamine (consult for IV Ketamine if pain remains severe after 2-3 IN doses)
(3-5 min b/w each medication to assess effectiveness)
MICA: IV Ketamine - analgesic dose
What is the CPG suggestion regarding:
Paracetamol doses
A0501-1 - Pain Relief
1000mg
500mg (<60kg/frail/elderly/malnourished/liver disease)
What is the CPG suggestion regarding:
IV Morphine doses
A0501-1 - Pain Relief
**ALS: **
- Up to 5mg @ 5/60 intervals
- Consult after 20mg)
MICA:
As above w/no max dose
What is the CPG suggestion regarding:
IM Morphine doses
A0501-1 - Pain Relief
10mg
- Rpt 5mg @ 15/60 if required
- Only one rpt allowed
0.1mg/kg (<60kg/frail/elderly), no repeat dose
What is the CPG suggestion regarding:
Methoxyflurane doses
A0501-1 - Pain Relief
3mL
Rpt once for a max of 6mL
What is the CPG suggestion regarding:
IV Fentanyl doses
A0501-1 - Pain Relief
**ALS: **
- Up to 50mcg @ 5/60 intervals
- Consult after 200mcg
MICA:
- As above w/no max dose
What is the CPG suggestion regarding:
IN Fentanyl doses
A0501-1 - Pain Relief
200mcg
- Rpt up to 50mcg @ 5/60 if required
- Max 400mcg IN
100mcg (<60kg/frail/elderly), Rpt at 5/60, Max 200mcg IN
What is the CPG suggestion regarding:
IM Fentanyl
A0501-1 - Pain Relief
100mcg
- Rpt 50mcg @ 15/60 if req (once only)
1mcg/kg (<60kg/frail/elderly), no rpt
What is the CPG suggestion regarding:
IN Ketamine doses
A0501-1 - Pain Relief
75mg
- Rpt 50mg @ 20/60 intervals
- No max dose
50mg (<60kg/frail/elderly), Rpt 25mg @ 20/60 intervals, no max
What is the CPG suggestion regarding:
IV Ketamine doses for Analgesia
A0501-1 - Pain Relief
ALS:
- Consult only
MICA:
IV - Analgesic:
- 10-20mg @ 5-10/60 intervals
IV - Procedural:
- Consider 20-30mg @ 2/60 intervals until dissociated/analgesed
IV - Infusion:
- 0.1 - 0.3mg/kg/hr
