Medical First Aid Guide
Table 13: PAIN RELIEF
The use of analgesics (pain-killing drugs) is a very important step in the treatment of poisoning associated with severe tissue damage. Pain relief calms the casualty and stabilizes his condition. Paracetamol is a mild analgesic and morphine is used to treat severe pains. As morphine often causes vomiting, it should be combined with an anti-emetic such as metoclopramide.
- Give two tablets of paracetamol every 6 hours until the pain is relieved.
Casualty is breathing normally:
- RADIO FOR MEDICAL ADVICE.
- If advice is not available:
- Give morphine sulphate 10 mg and metoclopramide 10 mg intramuscularly.
- If breakthrough pain persists after 15 minutes or more, give a second injection of 10 mg of morphine sulphate intramuscularly.
- After 4 hours, if pain persists or recurs, give 10 to 20 mg morphine sulphate with a further dose of 10 mg metoclopramide intramuscularly.
- Where pain persists, the third and subsequent doses of 10 to 20 mg morphine sulphate must not be given more frequently than every 4 hours with metoclopramide 10 mg but the total dose of metoclopramide must not exceed 30 mg each 24 hours.
- Follow medical advice if available.
Casualty is breathing poorly:
- Administer oxygen at a flow rate of 6 to 8 L per minute.
- RADIO FOR MEDICAL ADVICE. Evacuation to shore hospital is likely to be needed.
- If medical advice is not available and the pain is excruciating, give morphine sulphate 10 mg and metoclopramide 10 mg intramuscularly.
- If breakthrough pain persists after 15 minutes or more, give a second injection of 10 mg of morphine sulphate intramuscularly. OBSERVE CAREFULLY FOR FURTHER DETERIORATION.
- RADIO FOR MEDICAL ADVICE if not received previously.
- The following signs may indicate over-treatment with morphine:
- Irregular breathing pattern;
- Shallow and slow breathing;
- Development of unconsciousness if the casualty was conscious at first;
- Small pin-point pupils.
- If breathing is inadequate, give ventilation support and administer oxygen: see table 3.
- RADIO FOR MEDICAL ADVICE
- If medical advice is not available, give 0.4 mg naloxone intramuscularly. Naloxone counteracts the side effects of morphine.
- Repeat the dose within 15 minutes if the casualty’s condition does not improve and medical advice is not available.
- If there is no improvement after these two injections (total dose of 0.8 mg) of naloxone, it is very unlikely the deterioration is due to an overdose of morphine.
- If there is a response, and then further deterioration occurs, give a further dose of 0.4 mg of naloxone.
- Obtain RADIO MEDICAL ADVICE if at all possible prior to the use of morphine. Keep an exact record of morphine use.
- Keep an exact record of morphine use.
- Keep stock locked away.
- Discontinue as soon as the pain can be relieved by paracetamol.
- If, under certain radio conditions, radio medical advice is not feasible, it is up to the master’s discretion to ensure that adequate morphine is administered when pain is excruciating.