Week 2

Question 1

Pain definition

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such

Question 2

Nociceptive pain

Answer 2

Caused by stimulation of the peripheral sensory nerve fibres in response to a stimulus/injury

Question 3

Inflammatory mediators

Answer 3

prostaglandins, histamine, cytokines + bradykinin - further perpetuate nociceptors, further increasing pain

Question 4

Barriers to effective pain management

Answer 4

Caregiver beliefs
Characteristics of pain management
System barriers

Question 5

Pain relief CPG care objectives

Answer 5

To reduce the suffering associated with the experience of pain to a degree that the patient is comfortable

Question 6

Major trauma basic pain relief methods

Answer 6

High dose IV opioids
Consider IN or methods if IV delayed
Extra analgesia for extrication/procedures
Paracetamol in awake pts
Other interventions (e.g. splinting) to reduce pain

Question 7

Moderate pain with IV access

Answer 7

Opioids IV + paracetamol

Question 8

Moderate pain without IV access

Answer 8

IN fentanyl or IN ketamine + paracetamol

Question 9

When to use IM morphine

Answer 9

Moderate pain without IV access and IN fentanyl/IN ketamine is contraindicated/has limited effect

Question 10

Severe pain

Answer 10

Opioids + ketamine

Question 11

Moderate procedural pain

Answer 11

Methoxyflurane

Question 12

Severe procedural pain

Answer 12

IN ketamine

Question 13

Fentanyl indications

Answer 13

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

Question 14

Ketamine precaution populations

Answer 14

Anxiety/psychosis history
Adolescent/elderly/frail

Question 15

Morphine IV dose

Answer 15

Up to 5mg at 5 min intervals
Consult after 20mg

Question 16

Morphine IM dose

Answer 16

10mg, repeat 5mg after 15min if required (once only)
0.1mg/kg for <60kg, elderly, frail - no repeat dose

Question 17

Fentanyl IV dose

Answer 17

Up to 50mcg at 5 min intervals, consult after 200mcg

Question 18

Fentanyl IN dose

Answer 18

200mcg, repeat up to 50mcg at 5 min intervals if required (max 400mcg IN)
100mcg for <60kg, elderly, frail - repeat up to 50mcg at 5 min intervals if required (max 200mcg IN)

Question 19

Fentanyl IM dose

Answer 19

100mcg, repeat 50mcg after 15 minutes if required (once only)
1mcg/kg for <60kg, elderly, frail - no repeat dose

Question 20

Ketamine IN dose

Answer 20

75mg, repeat 50mg at 20min intervals (no max dose)
50mg for <60, elderly, frail - repeat 25mg at 20 min intervals (no max dose)

Question 21

Ketamine IV dose (consult only)

Answer 21

10-20mg at 5-10min intervals

Question 22

Moderate pain paediatric

Answer 22

Fentanyl IN or methoxyflurane if unable to administer fentanyl or moderate to severe procedural pain
Consider paracetamol

Question 23

Severe pain paediatric

Answer 23

Fentanyl IN +/- methoxyflurane

Question 24

Paracetamol paediatric dose

Answer 24

15mg/kg

Question 25

Fentanyl IN dose paediatric

Answer 25

Small child (10-17kg): 25mcg Medium child (18-39kg): 25-50mcg Repeat initial dose at 5-10min intervals (consult after 3 doses or for children <10kg)

Question 26

Paracetamol onset, peak, and duration

Answer 26

Onset: 30 min Peak: N/A Duration: 4 hours

Question 27

Methoxyflurane onset, peak and duration

Answer 27

Onset: 8-10 breaths Peak: N/A Duration: 3-5min after discontinued use or 25 min for 3mL

Question 28

Fentanyl peak, onset, duration

Answer 28

IV Onset: immediate Peak: <5min Duration: 30-60 min IN Peak: 2 min

Question 29

Morphine onset, peak and duration

Answer 29

IV Onset: 2-5 min Peak: 10 min Duration: 1-2 hours IM Onset: 10-30 min Peak: 30-60 min Duration: 1-2 hour

Question 30

Ketamine onset, peak, duration (IN)

Answer 30

Onset: 5 min Peak: 20 min Duration: 45 min

Question 31

How much blood can be missed in long bone fracture?

Answer 31

10-30% of total blood volume

Question 32

General principles of splinting

Answer 32

Alleviates pain and minimise further injury Facilitates transport Immobilise joints in position of comfort Ensure good perfusion below injury Joints only realigned if no distal pulse Elevate extremity if possible

Question 33

Fracture CPG care objectives

Answer 33

Control external haemorrhage Apply good splinting practices Resolve neurological or vascular compromise where possible Use judicious analgesia