Status
Complaint of pain
See also (at end of this CPG): - Pain Assessment - FLACC - Wong-Baker FACES Pain Rating Scale - Verbal Numerical Rating Scale
Determine requirement for Non IV therapy vs IV Therapy

Non IV therapy Pain likely to be controlled by non IV therapy Unaccredited for IV or unable to obtain IV • Consider Methoxyflurane and/or Fentanyl IN if appropriate • Methoxyflurane 3ml - Repeat Methoxyflurane 3ml if required (max. 6ml) • Fentanyl IN 2mcg/kg IN - Repeat Fentanyl IN up to 1mcg/kg, 5 minutely titrated to obtain pain reduction to comfortable/tolerable level or side effects (max. 4mcg/kg) Ensure accurate dose/vol. calculation • Wt. >25kg prepare dose from Fentanyl 600mcg/2ml • Wt. ≤25kg prepare dose from Fentanyl 100mcg/2ml • Exercise extreme caution with Fentanyl 600mcg/2ml as an incorrect vol. has the potential to overdose the Pt • If pain not controlled by above and unable to obtain IV access/not accredited: - Morphine 0.1mg/kg IM - Single dose - consult with the RCH or the receiving hospital for further doses

IV therapy Pain may require IV narcotic and ongoing therapy • Morphine 0.05-0.1mg/kg IV - Repeat Morphine up to 0.05mg/kg, 5 to 10 minutely - Titrated to obtain pain reduction to comfortable/ tolerable level or side effects - max Morphine 0.2mg/kg IV without consultation