Adult Pain Relief CPG Flashcards
Mild pain relief options
Paracetamol oral
Moderate pain relief options
First line - IV morphine, IV fentanyl
IV Access not req, delayed or unsuccessful - IN fentanyl, IN Ketamine
All pts unless contraindicated - oral paracetamol
Second line - IN Ketamine, IM Morphine
Third line OR Mild/moderate procedural pain - Methoxyflurane
Severe pain relief options
First line - IV morphine or IV Fentanyl AND IN Ketamine. Consult for Ketamine IV if pain remains severe following 2-3 doses
Second line - Fentanyl IN and/or Ketamine IN and/or Methoxyflurane and/or IM Morphine (if opioid not already administered)
Which drugs are not suitable to treat Chest Pain in suspected ACS?
- Paracetamol
- Ketamine
Paracetamol adult dose
- 1000mg (2 x tablets)
- 500mg if elderly/frail/malnourished/liver disease/under 60kg
Methoxyflurane Dose
3mL inhaled
Repeat 3mL if req
Max dose 6mL
IV Morphine Doses
Up to 5mg at 5min intervals
repeat every 5 mins
Max dose 20mg - Consult
IM Morphine doses
10mg IM
Repeat 5mg after 15 mins
Single repeat only
Elderly/frail/under 60kg - 0.1mg/kg
Single dose only
IV Fentanyl Doses
Up to 50mcg initial dose
Repeat 5 min ints
Max dose 200mcg
IN Fentanyl doses
200mcg (4 sprays) initial dose
Repeat 50mcg at 5 min ints
Max dose 400mcg
Elderly frail dose
100mcg loading
Repeat 50mcg at 5 min ints
Max 200mcg
IM Fentanyl doses
100mcg
Repeat 50mcg once only at 15 mins
OR elderly frail - 1mcg/kg
No repeat dose
IN / IV Ketamine dose
75mg
Repeat 50mg at 20 min ints
No max dose
OR elderly / frail / under 60kg
50mg
Repeat 25mg at 20 min ints
No max dose
IV - consult only
When to use IM Morphine
IN fentanyl / IN Ketamine is contraindicated / has limited effect AND IV access is not available
eg no IV access with facial trauma
When is fentanyl preferred over morphine
- Contra to morphine
- Short duration of action desirable
- Hypotension
- N+V
- Severe headache
Preparation of Ketamine infusion
50mg Ketamine with 50mL NS
Makes 1mg/mL
Infusion rate 0.1-0.3mg/kg/hr
