Paediatric Pain Flashcards
Pain Mgx as per SD3
- RR
- Position - POC
- MICA ? - Unwell Patient
- Pain relief - Paracetamol/Fentanyl IN, Methoxy
- Antiemetic - Ondans 2/4mg
- MICA up/downgrade/cancel/sitrep
- Extrication - wheelchair to stretcher
- Reassess VSS 10/60
- Load Signal ? MICA ?
Parietal Pain
Parietal pain is caused by irritation of the peritoneal lining that surrounds the abdominal cavity.
Visceral Pain
Visceral pain is pain related to the internal organs in the midline of the body
Somatic Pain
Somatic is generally described as musculoskeletal pain. It occurs when pain receptors in tissues (including the skin, muscles, skeleton, joints, and connective tissues) are activated.
Methoxyflurane Mode of Action
Inhaled anaesthetic – produces analgesia at low concentrations, however the exact mode of
action is unknown
Methoxyflurane Indications
Analgesia
Methoxyflurane Contraindications
Pre-existing renal disease
Known (or genetic susceptibility) to malignant hyperthermia
Methoxyflurane Precautions
Patients should not be administered > 6 mL of methoxyflurane in a 24 hour period, due to increased risk of nephrotoxicity
To limit occupational exposure, methoxyflurane should not be administered in a confined space. Ensure adequate ventilation in ambulance. Place used Penthrox inhalers in a closed plastic bag when not in use.
Methoxyflurane Adverse Effects
CNS: Dizziness, drowsiness
CV: Hypotension
GIT: Nausea and vomiting
Methoxyflurane Onset/Duration Times
Onset of action: Within 6 to 10 breaths
Duration of action: Effects last 3-5 minutes after stopping the inhalation. One vial provides up to 25 minutes of analgesia with continuous use
Paracetamol Pharmacology
Analgesic and antipyretic – exact mechanism of action is unclear; thought to inhibit prostaglandin synthesis in the CNS
Paracetamol Indications
Mild pain, or pain relief in combination with other analgesics
Headache
Paracetamol Contraindications
Children < 1 month of age
Paracetamol Precautions
Hepatotoxicity can occur with overdose. Do not administer if paracetamol has already been given within past 4 hours, or if total paracetamol intake within past 24 hours exceeds 4g (adults) or 60 mg/kg (children)
Risk of hepatotoxicity is increased in the following circumstances:
- Impaired hepatic function or liver disease
- Elderly / frail patients
- Malnourishment
Paracetamol Adverse Effects
Hypersensitivity reactions including severe skin rashes (rare)
Haematological reactions (rare)
Hypotension has been reported with IV infusion, particularly in critically ill patients
Paracetamol Onset and Duration Times
Onset of action: 30 minutes (oral), 5-10 minutes (IV)
Duration of action: 4 hours
Fentanyl Pharmacology
A synthetic opioid analgesic
Actions:
CNS effects:
- Depression – leading to analgesia
- Respiratory depression – leading to apnoea
- Dependence (addiction)
Cardiovascular effects:
- Decreases conduction velocity through the A-V node
Fentanyl Indications
- Sedation to facilitate intubation (RSI - modified or Paediatric IFS)
- Sedation to maintain intubation
- Sedation to facilitate transthoracic pacing
- Sedation to facilitate synchronised cardioversion
- CPR interfering patient - ALS
- Analgesia – IV/IN
- History of hypersensitivity or allergy to morphine
- Known renal impairment / failure
- Short duration of action desirable
- Hypotension
- Nausea and/or vomiting
- Severe headache
Fentanyl Contraindications
- History of hypersensitivity
- Late second stage of labour
Fentanyl Precautions
- Elderly/frail patients
- Impaired hepatic function
- Respiratory depression, e.g. COPD
- Current asthma
- Patients on monoamine oxidase inhibitors
- Known addiction to opioids
- Rhinitis, rhinorrhea or facial trauma (IN route)
Fentanyl Side Effects
Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles
Bradycardia
Fentanyl Onset/Duration/Peak times
IV effects:
Onset: Immediate
Peak: < 5 minutes
Duration: 30 - 60 minutes
IN effects:
Peak: 2 minutes
Different Types of Pain Scales
FLACC
Faces Pain Scale - Wong Baker
Verbal Pain Scale
