analgesia Flashcards
indications for paracetamol
mild or moderate pain (usually in combination with ibuprofen).
precautions with paracetamol
aracetamol taken within the last four hours.
ū Abdominal pain, particularly if very unwell or vomiting.
ū Known severe liver disease.
doseage of paracetamol
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.
contradictions of ibuprofen
third trimester of pregnancy
cautions of ibuprofen
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.
dosage of ibuprofen
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.
tramadol indications
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.
contraindications of tramadol
less than 12
cautions for tramadol
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.
methoxy contraindications
ū Personal or family history of malignant hyperthermia.
ū Unable to obey commands.
ū Known renal impairment.
ū Methoxyflurane administered within the last week.
cautions of methoxy
ū Aged greater than or equal to 75 years.
ū Pre-eclampsia.
ū In a confined space.
fentanyl contraindications
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).
fentanyl cautions
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.
fentynal dosage for IV,IM, SC
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.
fentanyl IN dosage
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.
ketamine indications
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.
cautions for ketamine
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.
ketamine analgesia dosage
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.
ketamine analgesia dissociation dosage
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.
midazolam indications
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.
midazolam contraindcations
ū Aged less than 12 years.
ū Unable to obey commands.
midazolam cautions
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.
IO lignocaine indication
significant bone pain associated with intraosseous administration.
IO lignocaine dosage
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.
indication for Ring blocks using 1% lignocaine
moderate to severe pain associated with isolated injuries to digits.
contraindications for Ring blocks using 1% lignocaine
infection at the site
cautions fo rRing blocks using 1% lignocaine
taking anticoagulant
maximum dosage of Ring blocks using 1% lignocaine
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.
Fascia iliaca block using 0.375% ropivacaine indication
moderate to severe pain associated with fractured neck of femur, fractured shaft of femur or dislocated hip.
contraindications of Fascia iliaca block using 0.375% ropivacaine
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.
contraindications of Fascia iliaca block using 0.375% ropivacaine
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.
handover pneumonic
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.
SITREP pneumonic
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.
death may be verified when
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.
death may be verified when
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.
clinical verification of death criteria
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.
nasal prongs 02 rate
1-4 litres/minute.
simple mask flow rate
6-8 L
neb mask rate
8L/m
reservoir msk rate
10-15 L/m
manual ventilation 02 rate
10-15 L
what should be administered prior to ketamine
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.
ketamine mechnism
- 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.
fent mechnism
- 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.
explain why midoazolam can be used as a pain relief
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.
what should occur prior to administering midaolam for pain relief
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.
midazolam mechanism
- 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.
what is the goal of a fascia iliaca block
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.
