Pain relief

Question 1

In regard to pain relief, what should you do in small, frail or elderly patients?

Answer 1

Consider dose reductions or longer dose intervals

Question 2

When should the paramedic consult for further doses of analgesia?

Answer 2

They can consult for IV ketamine or for further doses of opioids in any circumstance where the maximum doses have been reached but the patient remains in pain

Question 3

What is multi-modal analgesia?

Answer 3

It is the preferred approach where possible. It involved using smaller doses of multiple different agents instead of larger doses of a single agent. The effect is usually improved pain relief and less adverse effects.

Question 4

What drugs should be given for mild pain?

Answer 4

• PO paracetamol

**Paracetamol should not be given in suspected ACS

Question 5

What should be given for moderate pain?

Answer 5

First line

IV access available
- Morphine or Fentanyl IV

IV access not required, delayed or unsuccessful:
- Fentanyl IN (preferred in elderly pts)
OR
- Ketamine IN

All patients unless contraindicated
- PO paracetamol

Second line

Other options unsuccessful/unavailable/contraindicated

• Ketamine IN (if minimal response to opioids)
• Morphine Im (if opioid not already admin)

Third line OR mild/moderate procedural pain
- Methoxyflurane

Question 6

What drugs should be given in a patient with severe pain?

Answer 6

First line
- Morphine or Fentanyl IV
AND
- Ketamine IN (consult for ketamine IV if pain remains severe following 2-3 doses

allow 3-5mins between each medication to assess effectiveness

Second line
- Fentanyl IN
and/or
- Ketamine IN
and/or
- Methoxyflurane
and/or
- Morphine IM (if opioid not already administered)

Third Line

• MICA*
• Ketamine infusion
• ETT

Question 7

Can you give ketamine for cardiac chest pain?

Answer 7

No

Question 8

Fentanyl is preferred for patients with..

Answer 8

• Contraindications to morphine
• Short duration of action desirable (dislocations)
• Hypotension
• Nausea and/or vomiting
• Severe headache

Question 9

Can ketamine be given to patients with psychosis history for pain relief?

Answer 9

It is not preferred and should be administered with caution

Question 10

How much dead space do you need to allow for in IN doses?

Answer 10

0.1ml

Question 11

What are some non-pharmacological pain management strategies?

Answer 11

• Splinting

- Cold/heat therapy

Question 12

What should you assess when assessing a patient for pain?

Answer 12

• Reported level of pain
• Physical signs of discomfort
• Acute vs chronic
• Analgesia already taken
• Opioid tolerance
• Co-morbidities