Protocols - Hemorio

HOSPITALIZATION TRETAMENT:
MORPHINE EV EVERY 4/4H + DICLOPHENAC EVERY 8/8H (ALTERNATING WITH
DIPIRONE EVERY 4/4H) DURING 48H (RECEIVING AN PAIN KILLER EVERY 2 HOURS)
Note: To adjust daily dose and maintain SOS prescription, in addition to regular prescription.
OPIOID PAINKILLER:
MORPHINE:
1 amp = 1ml
(1ml = 10 mg)
METHADONE
1amp = 1ml
(1ml = 10 mg)
OPIOID
ANTAGONIST
(NALOXONE)
PAIN IN PREGNAT WOMEN:
INTRODUCTION
RESOLVED ?
YES
MAINTAIN DICLOPHENAC + DIPIRONE + REDUCE
OPIOID DOSE BY 25% EVERY 24 H
WHEN YOU ARE WITHOUT MORPHINE DISCHARGE
WITH:
CODEÍNE + DICLOPHENAC PO (proceeding the drug
withdrawn like in the outpatient model (pain 6 to 9).
ADULTS: 0.1 mg/Kg/dose EV or IM or SC (IM administration is uncertain and depend on blood
flow, which is not good to control the pain )
CHILDREN (OLDER THAN 6 MONTHS): 0.1 to 0.3 mg/Kg IV (infusion dose = 0.01 – 0.04
mg/Kg/hour = 10 a 40 mg/Kg/hour)
0.1 – 0.2 mg/Kg/dose SC or IM or IV. Administration interval must be increased every 4 days
(Ex.: 6/6h then 8/8h, etc.) If the patient already take Methadone VO, dose may be started on
VO 2:1 IV ratio (See conversion table for methadone administration under several ways of
dosage forms and administration).
ADULTS: 0.04 to 0.08 mg EV every 60 seconds until reversion of the picture.
CHILDREN (OLDER THAN 6 MONTHS): 2 to 10 mg/Kg/iV in bolus. Repeat the dose until it
becomes medically effective, reaching 100 mg/Kg. Then, repeat, as necessary,. It may be
indicated an infusion at 1mg/Kg/h dose.
Very few studies were performed about this issue.
Pain treatment during pregnancy is complicated due to several changes that
occur in the body system of a pregnant woman that influences
pharmacodynamics and pharmakinetics processes, as gastric absorption
delay, increase of distribution volume of the pregnant woman, etc. All this
factors make difficult to have a prognostic about the amount of drug that will
go effectively to the fetus.
Opioids are the most used drugs, but only on severe pain and for a little
while.
15
MAINTAIN THE SAME SCHEME WITH REAVALUATION AFTER 48 H
YES
NO
RESOLVED ?
NO
TO EVALUATE THE CAUSE OF PAIN + CONSIDER
DISCUSSION ABOUT TRANSFUSION WITH
INTERDISCIPLINARY GROUP