Pain Relief

Question 1

When is fentanyl preferred over morphine? (5)

Answer 1

Contraindication to morphine
Short duration of action desirable 
Hypotension 
Nausea/vomiting 
Severe headache

Question 2

Mx options for mild pain (adult) (1)

Answer 2

Panadol 500mg/1000mg

Question 3

Mx options for moderate pain (adults) (5)

Answer 3

IV morphine up to 5mg
IV fentanyl up to 50mcg
IN fentanyl 100mcg/200mcg
Penthrane 3ml
Panadol 500mg/1000mg

Question 4

Adult fentanyl IV dosing (non-frail)

Answer 4

50mcg
Repeat 50mcg every 5/60
Max dose 200mcg

Question 5

Adult fentanyl IN dosing (non-frail)

Answer 5

200mcg
Repeat up to 50mcg every 5/60
Max dose 400mcg

Question 6

Adult fentanyl IN dosing (frail)

Answer 6

100mcg
Repeat up to 50mcg every 5/60
Max dose 200mcg

Question 7

Adult morphine IV dosing

Answer 7

Up to 5mg
Repeat up to 5mg every 5/60
Max dose 20mg

Question 8

Adult penthrane dosing

Answer 8

3ml
Repeat 3ml
Max 6ml

Question 9

Mx options for severe pain (adult)

Answer 9

IV morphine
IV fentanyl
IN fentanyl
IM morphine 10mg/0.1mg/kg
Consult for IV ketamine

Question 10

IM morphine dosing for frail adult

Answer 10

0.1mg/kg single dose only

Question 11

IM morphine dosing non-frail adult

Answer 11

10mg IM

Repeat 5mg once only after 15/60

Question 12

Warming signs of serious intracranial event (5)

Answer 12

Abnormal neurological findings/atypical aura
New onset headache in older pts (>55) or Hx of cancer
Altered consciousness/collapse
Seizure
Fever/neck stiffness

Question 13

What fluids can you give for headache (adequately perfused but significantly dehydrated)?

Answer 13

N/saline 20ml/kg over 30/60

Question 14

Mx for headache

Answer 14

PO paracetamol
IM stemetil
IV/IN fentanyl for pain
IVT if dehydrated

Question 15

What is the pain scale goal for headache Mx?

Answer 15

<7

Question 16

When is fentanyl given for headache?

Answer 16

15 mins post paracetamol + stemetil if remains severe and hospital >15 mins away

Question 17

Panadol dose for paeds

Answer 17

15mg/kg

Question 18

Liquid Panadol presentation

Answer 18

24mg/ml

Question 19

Mx for mild pain in paeds

Answer 19

Panadol PO 15mg/kg

Question 20

Mx for moderate pain in paeds

Answer 20

IN fentanyl
PO paracetamol
Penthrane

Question 21

IN fentanyl dosage for small child (10-17kg)

Answer 21

25mcg IN
Repeat at 5-10/60
Consult after 3 doses

Question 22

IN fentanyl dosage for medium child (18-39kg)

Answer 22

25-50mcg IN
Repeat at 5-10/60
Consult after 3 doses

Question 23

IN fentanyl dosage for paeds <10kg

Answer 23

Consult with RCH

Question 24

Paeds penthrane dosage

Answer 24

3ml
Repeat 3ml
Max 6ml

Question 25

IM morphine dosage for paeds

Answer 25

0.1mg/kg once only as last resort | Max 5mg