analgesia

Question 1

indications for paracetamol

Answer 1

mild or moderate pain (usually in combination with ibuprofen).

Question 2

precautions with paracetamol

Answer 2

aracetamol taken within the last four hours.
ū Abdominal pain, particularly if very unwell or vomiting.
ū Known severe liver disease.

Question 3

doseage of paracetamol

Answer 3

ū 1.5 g PO for an adult weighing greater than 80 kg.
ū 1 g for an adult weighing 80 kg or less.
ū See the paediatric drug dose tables for a child.

Question 4

contradictions of ibuprofen

Answer 4

third trimester of pregnancy

Question 5

cautions of ibuprofen

Answer 5

ū Ibuprofen taken within the last four hours.
ū Abdominal pain, particularly if very unwell or vomiting.
ū Aged greater than or equal to 75 years, particularly in the presence of
illness, infection or dehydration.
ū Dehydration or shock.
ū Known renal impairment.
ū Known bleeding disorder or clinically significant bleeding.
ū Known worsening of bronchospasm with NSAIDs.
ū Taking warfarin.
ū Pregnancy.

Question 6

dosage of ibuprofen

Answer 6

ū 600 mg PO for an adult weighing greater than 80 kg.
ū 400 mg PO for an adult weighing 80 kg or less.
ū See the paediatric drug dose tables for a child.

Question 7

tramadol indications

Answer 7

ū Moderate pain, particularly if personnel are not available to administer fentanyl.
ū Severe pain, particularly if personnel are not available to administer fentanyl or ketamine.

Question 8

contraindications of tramadol

Answer 8

less than 12

Question 9

cautions for tramadol

Answer 9

Tramadol taken within the last four hours.
Abdominal pain, particularly if very unwell or vomiting. Confusion.Aged greater than or equal to 75 years, particularly if there is a previous history of dementia or confusion.
ū Pregnancy.

Question 10

methoxy contraindications

Answer 10

ū Personal or family history of malignant hyperthermia.
ū Unable to obey commands.
ū Known renal impairment.
ū Methoxyflurane administered within the last week.

Question 11

cautions of methoxy

Answer 11

ū Aged greater than or equal to 75 years.
ū Pre-eclampsia.
ū In a confined space.

Question 12

fentanyl contraindications

Answer 12

ū Unable to obey commands (exceptions: ‘end of life care’, ‘rapid sequence intubation’ and ‘post intubation’ sections).
ū Respiratory depression (exceptions: ‘end of life care’, ‘rapid sequence intubation’ and ‘post intubation’ sections).

Question 13

fentanyl cautions

Answer 13

ū Aged less than one year.
ū High risk of respiratory depression.
ū Signs of shock.
ū Labour.
ū Concurrent administration of other opiates, ketamine or midazolam.
ū Elderly and/or frail.

Question 14

fentynal dosage for IV,IM, SC

Answer 14

ū 10-50 mcg IV every five minutes as required for an adult.
ū 50-100 mcg IM/SC for an adult if IV access cannot be obtained and IN
administration is inappropriate. This may be repeated once after 20
minutes.
ū See the paediatric drug dose tables for a child.

Question 15

fentanyl IN dosage

Answer 15

200 mcg IN for an adult weighing greater than 80 kg. Further doses of 100 mcg may be administered every ten minutes as required. Halve these doses if the patient is frail or physiologically unstable.
ū 100 mcg IN for an adult weighing 80 kg or less. Further doses of 50 mcg may be administered every ten minutes as required. Halve these doses if the patient is frail or physiologically unstable.
ū See the paediatric drug dose tables for a child. Further doses may be administered every ten minutes as required.

Question 16

ketamine indications

Answer 16

ū Severe pain that has not been adequately controlled with fentanyl, particularly musculoskeletal or burn pain.
ū Inducing dissociation so that a painful procedure may be performed, for example cardioversion or realignment of a fracture.

Question 17

cautions for ketamine

Answer 17

ū Unable to obey commands.
ū Active psychosis.
ū Hypertension or a clinical condition that may be made worse by
hypertension.
ū Current myocardial ischaemia.
ū Concurrent administration of sedatives or midazolam.
ū Elderly and/or frail.

Question 18

ketamine analgesia dosage

Answer 18

30 mg IV administered over approximately 15 minutes for an adult weighing greater than 80 kg. Repeat as required.
ū 20 mg IV administered over approximately 15 minutes for an adult weighing 80 kg or less. Repeat as required.
ū 0.5 mg/kg IM or PO for an adult, up to a maximum of 50 mg if IV access cannot be obtained. This may be repeated once after 20 minutes.
ū See the paediatric drug dose tables for a child.

Question 19

ketamine analgesia dissociation dosage

Answer 19

ū
ū
1 mg/kg IV for an adult, up to a maximum of 100 mg. This may be repeated once after five minutes.
2 mg/kg IM for an adult, up to a maximum of 200 mg if IV access cannot be obtained. This may be repeated once after 20 minutes.
See the paediatric drug dose tables for a child.

Question 20

midazolam indications

Answer 20

ICPs may administer midazolam if pain is associated with severe muscle spasm or severe anxiety, if adequate analgesia is not being achieved with fentanyl, and ketamine is not indicated.

Question 21

midazolam contraindcations

Answer 21

ū Aged less than 12 years.
ū Unable to obey commands.

Question 22

midazolam cautions

Answer 22

ū Altered level of consciousness.
ū High risk of respiratory depression.
ū Signs of shock.
ū Concurrent administration of opiates or ketamine.
ū Elderly and/or frail.

Question 23

IO lignocaine indication

Answer 23

significant bone pain associated with intraosseous administration.

Question 24

IO lignocaine dosage

Answer 24

ū 50 mg (5 ml of 1% lignocaine) over two minutes for an adult. Wait one further minute before administering intraosseous fluid.
ū See the paediatric drug dose tables for a child.
ū The dose may be repeated once after 15 minutes.

Question 25

indication for Ring blocks using 1% lignocaine

Answer 25

moderate to severe pain associated with isolated injuries to digits.

Question 26

contraindications for Ring blocks using 1% lignocaine

Answer 26

infection at the site

Question 27

cautions fo rRing blocks using 1% lignocaine

Answer 27

taking anticoagulant

Question 28

maximum dosage of Ring blocks using 1% lignocaine

Answer 28

ū 200 mg (20 ml of 1% lignocaine) for an adult. If more than 20 ml is required, do not dilute, and administer additional alternative analgesia.

Question 29

Fascia iliaca block using 0.375% ropivacaine indication

Answer 29

moderate to severe pain associated with fractured neck of femur, fractured shaft of femur or dislocated hip.

Question 30

contraindications of Fascia iliaca block using 0.375% ropivacaine

Answer 30

Contraindications: ū Aged less than 12 years. ū Infection at the site of injection. ū Previous surgery in the groin. ū Patient unable to cooperate.

Question 31

contraindications of Fascia iliaca block using 0.375% ropivacaine

Answer 31

Contraindications: ū Aged less than 12 years. ū Infection at the site of injection. ū Previous surgery in the groin. ū Patient unable to cooperate.

Question 32

handover pneumonic

Answer 32

Identification of the patient. * Mechanism of injury or the medical complaint. * Injuries identified or information related to the medical complaint. * Signs and symptoms. * Treatment provided and trends. * Allergies. * Medicines. * Background, including previous medical history. * Other, including information on family and social situation.

Question 33

SITREP pneumonic

Answer 33

ū Major incident declaration. ū Exact location of incident. ū Type of incident. ū Hazards (significant) identified. ū Access and egress. ū Number (estimated) of patients. ū Emergency services already present and extra resources required.

Question 34

death may be verified when

Answer 34

a) There are clear and obvious signs of death such as decomposition, rigor mortis or decapitation or b) All the clinical criteria below are met.

Question 35

death may be verified when

Answer 35

a) There are clear and obvious signs of death such as decomposition, rigor mortis or decapitation or b) All the clinical criteria below are met.

Question 36

clinical verification of death criteria

Answer 36

a) There must be no signs of breathing for one minute, and b) There must be no palpable central pulse, and c) There must be no audible heart sounds, and d) The pupils must be dilated and unreactive to light.

Question 37

nasal prongs 02 rate

Answer 37

1-4 litres/minute.

Question 38

simple mask flow rate

Answer 38

6-8 L

Question 39

neb mask rate

Answer 39

8L/m

Question 40

reservoir msk rate

Answer 40

10-15 L/m

Question 41

manual ventilation 02 rate

Answer 41

10-15 L

Question 42

what should be administered prior to ketamine

Answer 42

Prior to administering ketamine for pain, sufficient fentanyl should be administered so that further doses are not providing additional analgesia. This will usually require 150-200 mcg of fentanyl for an adult.

Question 43

ketamine mechnism

Answer 43

* Ketamine is an analgesic. It has complex actions, but is predominantly an N-methyl-d-aspartate (NMDA) receptor antagonist (blocker), resulting in inhibition of excitatory neurotransmitters in the brain. * Low doses cause analgesia, larger doses cause amnesia and dissociation, and high doses cause anaesthesia.

Question 44

fent mechnism

Answer 44

* Fentanyl is an opiate analgesic. It is an opiate agonist (or stimulator) that binds to opiate receptors in the brain and spinal cord causing analgesia.

Question 45

explain why midoazolam can be used as a pain relief

Answer 45

Midazolam does not have analgesic properties. However, midazolam has a role in reducing pain associated with severe muscle spasm or severe anxiety particularly if the patient has severe back pain or a dislocated joint.

Question 46

what should occur prior to administering midaolam for pain relief

Answer 46

Prior to administering midazolam for pain, sufficient fentanyl should be administered that further doses are not providing additional analgesia. This will usually require 150-200 mcg of fentanyl for an adult.

Question 47

midazolam mechanism

Answer 47

* Midazolam is a benzodiazepine. * Midazolam enhances the activity of gamma-aminobutyric acid (GABA) at GABA receptors within the central nervous system, resulting in anticonvulsant activity, sedation, amnesia, anxiolysis and muscle relaxation.

Question 48

what is the goal of a fascia iliaca block

Answer 48

The goal of a fascia iliaca block is to provide additional analgesia and reduce the need for fentanyl and/or ketamine, particularly if the patient is elderly and/ or frail. It is uncommon for the block to produce complete control of pain and in approximately 25% of patients the block will have no discernible effect.