Pain Relief

Question 1

Mild Pain (Adult)

Answer 1

Paracetamol Oral

Question 2

Moderate Pain (Adult)

Answer 2

**FIRST LINE
**

IV Access:
Morphine IV OR Fentanyl IV

NO IV Access:
Fentany IN or Ketamine IN

All Pt unless contraindicated Paracetamol

**SECOND LINE
**

Ketamine IN (if minimal response to opiods
Morphine IM (if opiod not already administered)

THIRD LINE OR moderate procedural pain
Methoxyflurane inhaled

Question 3

Pain Relief
Morphine IV Dose (Adult)

Answer 3

Morphine IV up to 5 mg @ 5/60 intervals
(ALS consult after 20 mg)

Question 4

Pain relief mod/severe
Fentanyl IV Dose (Adult)

Answer 4

Fentanl IV up to 50 mcg @ 5/60 intervals
(ALS consult after 200 mcg)

Question 5

Paracetamol Dose (Adult)

Answer 5

If not already adminstered in the last 4 hours or max dose not already administred 4 mg in 24 hours

Adult 1000 mg

OR

500 mg (<60 kg / frail / elderly / malnourished / liver disease)

Question 6

Ketamine IN Dose (Adult)

Answer 6

75 mg
- repeat 50 mg @ 20/60 intervals (no max dose)

50 mg (<60kg / elderly / frail)
- repeat 25 mg @ 20/60 intervals (no max dose)

Question 7

Methoxyflurane Dose

Answer 7

3ml
- repeat 3 ml if required (max. 6ml)

Question 8

Fentanyl IN Dose (Adult)
For Pain relief

Answer 8

200 mcg
- repeat up to 50 mcg @ 5/60 if required (max 400 mcg IN)

OR

100 mcg (<60 kg / frail / elderly)
- repeat up to 50 mcg @ 5/60 if required (max. 200 mcg IN)

Question 9

Severe Pain (Adult)

Answer 9

FIRST LINE

Morphine IV 5mg repeat 5/60 (max dose 20mg)
OR
Fentanyl IV 50mcg repeat 5/60
Max dose 200mcg
AND
Ketamine IN 75mg
Repeat 50mg IN
20/60

No max dose

(3-5 min between each medication to assess effectiveness)

SECOND LINE

Fenanyl IN 200mcg
Repeat 50mcg 5/60

and/or
Ketamine IN 75mg

and/or
Methoxyflurate 3ml

and/or
Morphine IM 10mg
Repeat 5mg 15/60 once only (if opiod not already administered)

Question 10

Mild Pain (Paediatric)

Answer 10

Paracetamol 15 mg/kg Oral
(if not already administered within the past 4 hours)

Question 11

Moderate Pain (Paediatric)

Answer 11

**Fentanyl IN
**
Small child (10-17 kg): 25 mcg
Medium child (18-39 kg) 25-50 mcg
Ado (>40kgs) 50-75mcg

• repeat initial dose @ 5-10min intervals. Consult after 3 doses

Consult w/ RCH for doses in children < 10kg

**If
Unable to administer Fentanyl IN OR procedural pain
**
Methoxyflurate 3 ml inhaled
- repeat 3ml if required (max 6 m)

Question 12

Mod/Severe pain Paediatric

Answer 12

Fentanyl IN
Small child 10-17kg 25mcg
Med child 18-39kg 25-50mcg

Repeat initial dose 5-10min , max 3 times
Consult

Paracetamol 15g/kg

Methoxyflurain 3ml