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CPG's COPY > Pain management > Flashcards

Pain management Flashcards

1
Q

What is the treatment for mild pain

A

Paracetamol 1000mg oral

or 500mg oral for old frail ppl

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2
Q

What are the contraindications for paracetamol

A
  1. Hypersensitivity
  2. Had paracetamol in last 4 hours
  3. Exceed max dose in last 24 hours
    - 4g for adults
    - 60mg/kg for paeds
  4. Chest pain associated with ACS
  5. Children under 1 month
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3
Q

What is the treatment for Moderate pain

A

IV Access available:
- IV Morphine or IV fentanyl
Morph: 5mg @5min intervals | max 20mg
Fent: 50mcg @ 5 min intervals | max 200mcg

HALF DOSE FOR OLD OR FRAIL

If IV Acess unavailable:
- Fentanyl IN
200mcg IN, repeat 50mch @ 5 mins max 400

HALF DOSE FOR FRAIL

Unable to administer IN Fent
- Methoxy 3mL
repeat 3mL to max dose of 6mL

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4
Q

What is the treatment for Severe pain

A

IV Access available:
- IV Morphine or IV fentanyl
Morph: 5mg @5min intervals | max 20mg
Fent: 50mcg @ 5 min intervals | max 200mcg

HALF DOSE FOR OLD OR FRAIL

If IV Acess unavailable:
- Fentanyl IN
200mcg IN, repeat 50mch @ 5 mins max 400

HALF DOSE FOR FRAIL

Unable to administer IN Fent
- Methoxy 3mL
repeat 3mL to max dose of 6mL

OR

IM Morph
- 10mg IM
repeat 5mgIM after 15 mins

FOR ELDERLY/FRAIL
Morph 0.1mg/kg IM single dose

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5
Q

What are the contraindications for Morphine

A
  1. Hypersensitivity
  2. Renail impairment
  3. Late 2nd stage labour
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6
Q

WHat are the contraindications for Fentanyl

A
  1. Hypersensitivity

2. Late 2nd stage labour

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7
Q

What are the contraindications for Methoxyflurane?

A
  1. Renal impairment
  2. Muscular dystrophy
  3. Family history of Malignant hyperthermia
  4. Had 6ml in last 24 hours
  5. Concurrent use of tetracycline antibiotics
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8
Q

What are the contraindications for Ketamine

A
  1. Suspected non-traumatic brain injury with severe hypertension over SBP 180
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9
Q

WHat is the dosage of IN Ketamine in the new pain management CPG

A

75mg @ 10 min intervals no max dose

FRAIL
50mg @ 10 mins no max

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10
Q

What is the mild pain management for paeds?

A

Paracetamol 15mg/kg

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11
Q

What is the management for Moderate pain in paeds?

A 
Fentanyl IN:
Small child (10-17kg) = 25 mcg
Medium child (18-39kg) = 25-50mcg

Repeat doses at 5-10 mins
COnsult after 3 doses

Methoxy 3ml max 6ml

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12
Q

What is the treatment for severe pain in paeds

A

Fentanyl IN +- Mehoxy

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13
Q

What are the side effects of Morphine

A

CNS effects:

  • Drowsiness
  • Resp depression
  • Euphoria
  • Nausea & vomiting
  • Addiction
  • Pin point pupils

Cardiovascular effects:

  • Hypotension
  • Bradycardia
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14
Q

What are the precautions for morphine

A
  1. elderly/frail
  2. Hypotension
  3. Respiratory depression
  4. Current asthma
  5. Respiratory tract burns
  6. addiction to opioids
  7. Acute alcoholism
  8. Pts on Monoamine oxidase inhibitors
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15
Q

What are the precautions for fentanyl

A
  1. elderly/frail
  2. Impaired hepatic function
  3. Respiratory depression
  4. Current asthma
  5. addiction to opioids
  6. Pts on Monoamine oxidase inhibitors
  7. Rhinitis or facial trauma
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16
Q

What are the side effects of fentanyl

A
  • Resp depression
  • Apnoea
  • Rigidity of the diaphragm
  • Bradycardia
17
Q

What are the precautions for paracetamol

A
  1. impaired hepatic function or liver disease
  2. elderly/frail
  3. malnourished
18
Q

What are the side effects of paracetamol

A

Hypersensitivity reactions

haematological reactions

19
Q

What are the precautions for methoxyflurane

A
  1. must be held by patient incase they lose consciousness
  2. pre-eclampsia
  3. concurrent use with oxytocin may cause hypotension
20
Q

What are the side effects of methoxyflurane

A
  • Drowsiness
  • Decrease BP and bradycardia
  • Exceeding max dose in 24 hours may lead to renal toxicity
21
Q

What is the onset peak and duration for fentanyl IV

A 
onset= immediate
peak= < 5mins
duration= 3-=60 mins
22
Q

What is the peak for fentanyl IN

A

peak 2 mins

23
Q

What is the onset peak and duration for morphine IV

A 
onset= 2-5mins
peak= 10 mins
duration= 1-2 hours
24
Q

What is the onset peak and duration for morphine IM

A 
onset= 10-30mins
peak= 30-60 mins
duration= 1-2 hours

CPG's COPY (28 decks)

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