CPG A0501/P0501 - Pain Relief

Question 1

CPG A0501 - PAIN RELIEF - MILD PAIN

Answer 1

Oral

Paracetamol 1000mcg (must not have been consumed in <4 hrs)

Paracetamol 500mcg oral (patient is <60kg, frail, malnourished or has liver impairment).

Question 2

CPG A0501 - PAIN RELIEF - MODERATE PAIN (IV)

Answer 2

Intravenous

Morphine up to 5mg (5mg @ 5 min intervals. >20mg seek consultation).

Fentanyl up to 50mcg (50 mcg @ 5 min intervals. >200mcg seek consultation).

Question 3

CPG A0501 - PAIN RELIEF - MODERATE PAIN ( NO IV)

Answer 3

Intranasal Atomiser

Fentanyl 200mcg (200mcg loading dose, 50mcg @ 5 min intervals. >400mcg seek consultation.)

Fentanyl 100mcg (frail/elderly/<60kg)
(100mcg loading dose, 50mcg @ 5 min intervals. >200mcg seek consultation.

Question 4

CPG A0501 - PAIN RELIEF - MODERATE PAIN (PROCEDURAL PAIN)

Answer 4

Methoxyflurane 3mL inhaled. Max 6mL.

Question 5

CPG A0501 - PAIN RELIEF - SEVERE PAIN (IV)

Answer 5

Morphine up to 5mg (5mg @ 5 min intervals. >20mg seek consultation).

Fentanyl up to 50mcg (50 mcg @ 5 min intervals. >200mcg seek consultation).

Question 6

CPG A0501 - PAIN RELIEF - SEVERE PAIN (NO IV)

Answer 6

Fentanyl IN, 200mcg (200mcg loading dose, 50mcg @ 5 min intervals. >400mcg seek consultation.)

Fentanyl IN, 100mcg (frail/elderly/<60kg)
(100mcg loading dose, 50mcg @ 5 min intervals. >200mcg seek consultation.

IM MORPHINE (LAST RESORT)
0.1mg/kg single dose (<60kg)
10mg (repeat 5mg after 15 mins if required).

Question 7

Paracetamol Presentation

Answer 7

500mg tablets

120mg in 5ml liquid (24mg/ml)

Question 8

Paracetamol Contraindications (5)

Answer 8

Hypersensitivity

Children <1 month old

Administered <4hrs ago

Intake in 24hrs exceeds 4g adults and 60mg/kg kids

Chest pain in suspected ACS

Question 9

Methoxyflurane Presentation

Answer 9

3ml glass bottle and penthrox inhaler

Question 10

Methoxyflurane Contraindications

Answer 10

Renal failure

Tetracycline antibiotics

Muscular dystrophy

Malignant hyperthermia

> 6mL in 24hrs

Question 11

Morphine Presentation

Answer 11

10mg in 1mL ampoule.

Draw up 9mL saline with 1mL morphine
to make it 1mg/mL

Question 12

Morphine Contraindications

Answer 12

Hypersensitivity

2nd stage labour

Renal Failure

Question 13

Fentanyl Presentation

Answer 13

100mcg in 2mL ampoule (IV)
Draw up 8mL saline with 2mL fentanyl
(to make it 10mcg/mL)

250mcg in 1mL cartridge (IN)
1 spray = 50mcg.
1 spray is used to prime the atomiser.

Question 14

CPG P0501 - PAED PAIN RELIEF - MILD PAIN

Answer 14

Paracetamol 15mg/kg if not given in last 4 hours

Question 15

CPG P0501 - PAED PAIN RELIEF - MODERATE PAIN

Answer 15

Fentanyl Intranasal Atomiser

10-17kg: 25mcg
18-39kg: 25-50mcg

Repeat 5-10min intervals.
Consult with RCH after 3 doses and if child <10kg.

Question 16

CPG P0501 - PAED PAIN RELIEF - SEVERE PAIN

Answer 16

Fentanyl Intranasal Atomiser

10-17kg: 25mcg
18-39kg: 25-50mcg

Consult with RCH after 3 doses

Methoxyflurane 3mL inhaler.