ANALGESIA GUIDLINES Flashcards
for mild pain administer
Administer paracetamol.
Consider administering ibuprofen.
when should methoxy be admisntered
Consider administering methoxyflurane if there will be a significant delay in an opiate being administered
when should tramadol and ibuprofen be administered
Consider administering ibuprofen and/or tramadol, particularly if an opiate is not going to be administered.
Paracetamol should be administered in addition to
ther medicines for severe pain, particularly if the transport time is long. This is not a priority but will reduce the need for subsequent analgesia and improve the quality of pain relief.
Ibuprofen is useful in the context of….
soft tissue pain, musculoskeletal pain and renal colic, particularly if an opiate is not going to be administered.
Paramedics, ICPs and CCPs may administer 1% lignocaine for
moderate to severe pain associated with isolated injuries to digits when transport time is less than 60 minutes
Fentanyl over morphine is usually the preferred opiate if:
The patient requires analgesia for a short period of time only, or
The patient has renal impairment, or
The patient has signs of shock.
Morphine is usually the preferred opiate if
The patient requires analgesia for a longer period of time, or
The patient is receiving palliative care.
ibuprofen mechanism
Inhibits activity of prostaglandin synthetase, reducing prostaglandin production which reduces inflammation, pain and fever
ibuprofen contraindications
Known severe allergy
Pregnancy
Presence of sepsis, dehydration, shock or clinically significant bleeding (Ibuprofen can worsen renal impairment and increase bleeding risk)
Known worsening of bronchospasm with NSAIDS
cautions of ibuprofen
Taken within last four hours (Additional ibuprofen may be administered if the total dose in the last 4 hours does not exceed the CPG dose)
Abdo pain, particularly if unwell or vomiting (The possibility of significant intra-abdominal pathology exists and oral meds should usually be withheld)
Age greater than 75 years particularly if frail (Renal impairment is likely and ibuprofen worsens this)
ibuprofen dosage
→ 600 mg over 80 kgs
→ 400 mgs over 80 kgs
ibuprofen side affects
Renal impairment
Increased bleeding
Long term indigestion, GI ulceration and bleeding
ibuprofen onset
30-60 mins
ibuprofen duration
4-6 hours
paracetamol mechanism
→ Inhibits production of prostaglandins reducing pain and fever
paracetamol indications
Mild to moderate pain
Moderate to severe pain, in combination to other meds
paracetamol contraindications
nil
paracetamol cautions
Patient taken paracetamol within last 4 hours
Abdo pain, particularly if pt is unwell or vomiting. (The possibility of significant intra-abdominal pathology exists and oral medicines should usually be withheld)
Known severe liver disease (Liver disease must be severely impaired before paracetamol clearance is altered, but usually withhold)
paracetamol dosage
→1.5 g PO weighing greater than 80 kgs
→ 1 g PO weighing less than 80 kgs
paracetamol adverse affects
nil
paracetamol duration
4-6 h
brofen dose for a 10kg 1 year old
100 mg (5ml)
paracetamol dosage for a 10kg 1 year old
150 mg, 3 ml (50 mg/ml)
Fentanyl mechanism
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.
indications of fentanyl
Moderate to severe pain.
Cardiogenic pulmonary oedema with severe anxiety.
Rapid sequence intubation.
Sedation post intubation.
Control of pain, agitation, or shortness of breath during end of life care.
fentanyl contraindications
allergy
fentanyl cautions
Altered level of consciousness. Fentanyl may further reduce the level of consciousness.
Aged less than one year. Children under the age of one year are at increased risk of respiratory depression following opiate administration.
Respiratory depression or at high risk of respiratory depression. For example, severe COPD, morbid obesity or on home BiPAP. Such patients may develop respiratory depression following opiate administration.
Labour. Opiates cross the placenta and may cause drowsiness and/or respiratory depression in the baby, particularly when administered within an hour or two of birth. Discuss administration with the lead maternity carer if possible. Following birth, close observation of the baby is required and personnel must be prepared to treat respiratory depression.
Concurrent administration of other opiates, ketamine or midazolam. This will increase and prolong the effects.
Aged greater than or equal to 75 years, particularly if frail. The effects of fentanyl will be increased and prolonged in this cohort.
Signs of shock. Fentanyl may make shock worse.
fentanyl and pregnancy
Safety has not been demonstrated in pregnancy, but fentanyl should be administered if indicated.
IV fentanyl adult dosage
IV for analgesia:
10-50 mcg every five minutes for an adult, as required. Use a dose at the lower end of the range if the patient is frail or has signs of shock.
paediatric fentanyl how to draw up
Fentanyl IV 10 mcg/ml (weight rounded up to 30 kg or more)
Draw up 2 ml of fentanyl from a 100 mcg/2 ml ampoule.
Dilute to a total volume of 10 ml using 0.9% sodium chloride.
Administer the volume from the tables as an IV bolus.
