pain relief

Question 1

headache: intracranial pathology s/s

Answer 1

1. sudden onset
2. worst in life
3. thunderclap
4. abnormal neurological findings
5. atypical aura
6. new onset headache in pts > 50 yo
7. new onset headache in pts with CA history
8. altered conscious state or collapse
9. seziure
10. neck stiffness / fever

Question 2

in what circumstances is fentanyl preferred over morphine?

Answer 2

1. shorter duration of action desired
2. hypotension
3. n/v
4. headache
5. morphine c/i

Question 3

moderate pain mx

Answer 3

1. IV morph upto 5mg rpt @ 5/60 max 20mg
2. IV fent upto 50mcg rpt @ 5/60 max 200mcg
3. IN fent non frail 200mcg + 50x4 (max 400mcg)
4. IN fent ‘frail’ 100mcg + 50x2 (max 200mcg)
5. procedural pain u/a IN fent methoxy

Question 4

severe pain mx

Answer 4

1. IV morph upto 5mg rpt @ 5/60 max 20mg
2. IV fent upto 50mcg rpt @ 5/60 max 200mcg
3. IN fent non frail 200mcg + 50x4 (max 400mcg)
4. IN fent ‘frail’ 100mcg + 50x2 (max 200mcg)
5. extreme traumatic - consult for ketamine IV

last resort

6. non frail - IM morph 10mg rpt 5mg @ 15/60
7. ‘frail’ - IM morph 0.1mg/kg once only

Question 5

mild pain mx

Answer 5

if no paracetamol within 4/24

1. 1000mg paracetamol - non frail
2. ‘frail’ 500mg paracetamol

Question 6

paracetamol CI

Answer 6

1. Hypersensitivity to paracetamol
2. Children < 1 month of age
3. Paracetamol already administered within past 4 hours
4. Total paracetamol intake within past 24 hours exceeding 4 g (adults) or 60 mg/kg
   (children 15mg/kg per dose)
5. Chest pain in suspected acute coronary syndrome

Question 7

paracetamol precautions

Answer 7

1. Impaired hepatic function or liver disease
2. Elderly / frail
3. Malnourished

Question 8

ketamine CI

Answer 8

1. known hypersensitivity

2. SBP > 180

Question 9

ketamine precaution

Answer 9

1. any condition where significant elevation in BP would be detrimental e.g.
   - CVA
   - HT
   - recent AMI
   - CCF

2.if being administered IV administer slowly to avoid respiratory depression.

Question 10

ketamine SE

Answer 10

Cardiovascular
- Increase in BP and HR

CNS

• Respiratory depression or apnoea
• Emergence reactions (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behaviour)
• Enhanced skeletal tone
• Nausea and vomiting
• Ocular
• Diplopia and nystagmus with slight increase in intraocular pressure

Other

• Local pain at injection site
• Lacrimation
• Hypersalivation

Question 11

Paediatric weights SC MC analgesia

Answer 11

SC 10-17kg MC 18-39kg < 10kgs