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trauma > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Pain definition

A

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

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2
Q

Nociceptive pain

A

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

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3
Q

Inflammatory mediators

A

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

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4
Q

Barriers to effective pain management

A

Caregiver beliefs
Characteristics of pain management
System barriers

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5
Q

Pain relief CPG care objectives

A

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

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6
Q

Major trauma basic pain relief methods

A

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

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7
Q

Moderate pain with IV access

A

Opioids IV + paracetamol

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8
Q

Moderate pain without IV access

A

IN fentanyl or IN ketamine + paracetamol

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9
Q

When to use IM morphine

A

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

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10
Q

Severe pain

A

Opioids + ketamine

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11
Q

Moderate procedural pain

A

Methoxyflurane

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12
Q

Severe procedural pain

A

IN ketamine

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13
Q

Fentanyl indications

A

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

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14
Q

Ketamine precaution populations

A

Anxiety/psychosis history
Adolescent/elderly/frail

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15
Q

Morphine IV dose

A

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

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16
Q

Morphine IM dose

A

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

17
Q

Fentanyl IV dose

A

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

18
Q

Fentanyl IN dose

A

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)

19
Q

Fentanyl IM dose

A

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

20
Q

Ketamine IN dose

A

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

21
Q

Ketamine IV dose (consult only)

A

10-20mg at 5-10min intervals

22
Q

Moderate pain paediatric

A

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

23
Q

Severe pain paediatric

A

Fentanyl IN +/- methoxyflurane

24
Q

Paracetamol paediatric dose

A

15mg/kg

25
Q

Fentanyl IN dose paediatric

A

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)

26
Q

Paracetamol onset, peak, and duration

A

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

27
Q

Methoxyflurane onset, peak and duration

A

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

28
Q

Fentanyl peak, onset, duration

A

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

29
Q

Morphine onset, peak and duration

A

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

30
Q

Ketamine onset, peak, duration (IN)

A

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

31
Q

How much blood can be missed in long bone fracture?

A

10-30% of total blood volume

32
Q

General principles of splinting

A

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

33
Q

Fracture CPG care objectives

A

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

trauma (4 decks)

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