Pain Management: Moderate-Severe

Question 1

Moderate-Severe Pain Management - Treatment Priorities

IV access

Answer 1

• consider non-pharmacological pain management options eg splinting
• Morphine:
  
  • AD: Morphine up to 5mg IV, repeated @5/60, max 20mg
• Fentanyl:
  
  • AD: Fentanyl up to 50mcg IV, repeated @5/60, max 200mcg

Question 2

Moderate-Severe Pain Management - Treatment Priorities

No IV access

Answer 2

• consider non-pharmacological pain management options eg splinting
• Fentanyl IN:
  
  • AD: Fentanyl 200mcg IN, repeat 50mcg @5/60, max 400mcg
  • Frail: Fentanyl 100mcg IN, repeat 50mcg @5/60, max 200mcg
  • PD L Child >40kg: Fentanyl 50mcg IN, repeat @5-10/60, max 3 doses
  • PD M Child 18-39kg: Fentanyl 25-50mcg IN, repeat @5-10/60, max 3 doses
  • PD S Child 10-17kg: Fentanyl 25mcg IN, repeat @5-10/60, max 3 doses
  • PD <10kg: consult RCH
• Methoxyflurane:
  
  • AD/PD: 3ml via penthrox inhaler, repeat @25/60, max 6ml
• Morphine IM:
  
  • AD: Morphine 10mg IM, repeat 5mg after 15/60, once only
  • Frail/PD: Morphine 0.1mg/kg IM, single dose