Pain Management

Question 1

Mild Pain

Answer 1

Paracetamol 1g oral (2 tablets) - if not administered within 4 hours
If pain not controlled or rapid pain relief required treat as per Moderate Pain

Question 2

Moderate Pain

Answer 2

If IV access available
Morphine IV or Fentanyl IV as per Severe Pain

If IV access unavailable

Fentanyl up to 100mcg IN (25mcg sprays)
 - repeat up to 50mcg IN after no less than 5 min intervals max dose 400mcg
OR
Methoxyflurane 3ml Inhaled
 - repeat 3ml as required

If unable to administered Methoxyflurane or Fentanyl IN:

Morphine up to 0.1mg/kg (max single dose 10mg) IM/SC
OR
Fentanyl up to 1mcg/kg (max single dose 100mcg) IM/SC
- repeated once if required after no less than 20 minutes

Question 3

Severe Pain

Answer 3

IV/IO Access available:

Morphine up to 0.05mg/kg IV/IO (max 5mg)
- repeat after no less than 5 minutes (max 20mg) titrated to pain or side effects
OR
Fentanyl 0.5mcg/kg IV/IO (max 50mcg)
- repeat after no less than 5 minutes (max 200mcg) titrated to pain or side effects

Question 4

Mild Pain

Answer 4

Paracetamol 1g - as long as hasn’t been given in <4 hours

If pain unresolved Rx as per Moderate Pain

Question 5

Moderate Pain

Answer 5

If IV Access Available:
Morphine IV or Fentanyl IV as per Severe Pain

If IV Access Unavailable
Fentanyl IN 100mcg (25mcg spray) 
 - Repeat up to 50mcg IN after no less than 5 mins
 - Max dose 400mcg 
OR
Methoxyflurane 3ml Inhaled
 - Repeat 3ml if required (max 6ml)

If unable to administer Fentanyl IN or Methoxyflurane:

Morphine 0.1mg/kg IM/SC (max single dose 10mg) OR Fentanyl up to 1mcg/kg (max single dose 100mcg) repeated ONCE if required after no less than 20mins

Question 6

Severe Pain

Answer 6

Morphine 0.05mg/kg IV/IO (Max single dose 5mg)
- Repeat after no less than 5 mins (max 20mg)

Fentanyl 0.5mcg/kg IV/IO (max single dose 50mcg)
-Repeat after no less than 5 mins (Max 200mcg)