POLIE 7 - pain Flashcards
Pain rating scales
Faces wongbaker 0,2,4,6,8,10
Numerical 1-10
Behavioural (FLACC)
Behavioural/physiological - (obs, posture, sleeping pattern, skin colour/sweating)
5 principles of pain med selection
WHO pain ladder
1) prescribe analgesia appropriate to severity of pain
2) take the CAUSE of pain into account
3) take action and assess outcome (r/v within short period (expected peak affect))
4) Check for allergies
5) Use pharma and non-pharma combo
differences prescribing in children vs adults
1) absorption
- GI function dependent
- Gastric acid higher infants
- neonates - reduced gastric emptying rates. transdermal - dangerous
2) distribution
- less plasma protein binding
- greater ECFV - greater vol of distribution
- NB high bilirubin levels - drug displacement from pp
3) metabolism
- clearance rates less at birth - immature enzyme systems
- higher metabolic rate children. need higher doses? mg/kg
4) excretion
- renal function immature till 6-8mo
- reduced renal excretion - new-born babies.
5) dosing according to age, weight, BSA, condition
age classification BMJ
- premature <36wks
- newborn 0-27days
- infant 28days - 12mo
- child 12mo to 11yo
- adolescent 12-18yo
Painstop
1ml :
24mg paracetamol
1mg codeine
paracetamol dosing
15mg/kg Q4hrly
MAX 100mg/kg/day / 4g/day
Codeine
0.5-1mg/kg
needle stick injury mx
1 - first aid: wash soap and water. milk
2 - report to line manager
3 - establish risk:
type of fluid and nature of exposure
4 - Order baseline blood fem exposed person HIV, HCV, antiHbS.
5 - if pt. infection status unknown – serology for HIV, HCV, anti=-HbS - “needlestick pack” pro forma: w coded lab forms
6 - follow up testing facitilities w needlestick packs - mx and coded lab form w specified tests. consult infectious diseases if doubts.
morphine dosing bolus
12mo and 50kg - 2mg for child
OR
intranasal fentanyl
