FLACC SCALE – University of Michigan Health System | |||
Face | 0 No particular expression or smile | 1 Occasional grimace or frown, withdrawn, disinterested | 2 Frequent to consent quivering chin, clenched jaw |
Legs | 0 Normal position or released | 1 Uneasy, restless, tense | 2 Kicking or legs drawn up |
Activity | 0 Lying quietly, normal position, moves easily | 1 Squirming, shifting back and forth, tense | 2 Arched, rigid or jerking |
Cry | 0 No cry (awake or asleep) | 1 Moans or whimpers, occasional complaint | 2 Crying steadily, screams or sobs, frequent complaints |
Consolability | 0 Content, relaxed | 1 Reassured by occasional touching or being talked to, distractible | 2 Difficult to console or comfort |
Drug | Dose | Route | Pain severity | Comments | Adverse effects |
Non-opioids | |||||
Paracetamol | 15–20 mg/kg/dose 4–6 hourly (maximum dose 90 mg/kg/day or 4 g/day adult) | 0/PR/IV | Mild to moderate | Opioid sparing effect. Review dose after 48 hours | Risk of hepatic impairment if prolonged use and/or high doses |
Ibuprofen | 10 mg/kg/dose 6–8-hourly (Maximum dose generally 600mg) | 0 | Mild to Moderate to severe | Caution if low BP or hypovolaemia. Opioid sparing effect. Least gastric irritating NSAID. Not for children under 3 months | Renal impairment, higher risk if hypotensive. Platelet dysfunction (not appropriate in haemorrhaging pt) |
Ketamine | 0.25-0.5mg/kg | IV | Severe | Dissociative anaesthetic. V effective analgesic where opiates are inadequate | Diplopia,nystagmus; emergence reaction (hallucination, delirium, confusion, irrational behaviour) |
Opioids | |||||
Codeine (if oxycodone not available) | 0.5–1 mg/kg/dose, 4–6-hourly (maximum dose 60 mg) | 0 / PR | Mild to moderate | 10 per cent of the population unable to metabolise. Do not give IV | Constipation and respiratory depression |
Oxycodone (use 1st oral) | 0.1–0.2 mg/kg/dose, 6-hourly | 0 /PR | Moderate | Do not give administer with codeine | Respiratory depression |
Morphine | 0.05–0.2 mg/kg/dose, 2–4-hourly | IV | Moderate to severe | Give in increments, such as 20 mcg/kg, titrate to effect | Respiratory depression and hypotension |
Fentanyl | 0.5–1 mcg/kg/dose | IV | Moderate to severe | Give in increments, titrate to effect | Respiratory depression and bradycardia |
First dose: 1.5mcg/kg/dose 2nd dose 10 minutes post: 0.75 – 1.5 mcg/kg | IN * |
History of tetanus vaccination | Type of wound | Tetanus vaccine booster | Tetanus Immunoglobulin | |
3 or more doses | < 5 years since last dose | All wounds | No | No |
5–10 years since last dose | Clean minor wounds | No | No | |
5–10 years since last dose | All other wounds | Yes | No | |
> 10 years since last dose | All wounds | Yes | No | |
< 3 doses or uncertain | Clean minor wounds | Yes | No | |
< 3 doses or uncertain | All other wounds | Yes | Yes |
A combination vaccine should be used in order to boost community protection against pertussis.
Please note that CDT and Tetanus Toxoid are no longer available.
<8 years old DTPa – IPV (Infanrix – IPV).
>8 years old dTPA (Boostrix).
Can use a diphtheria / tetanus toxoid vaccine (ADT) if pertussis vaccination is contraindicated.
Available from: http://www.rch.org.au/clinicalguide/guideline_index/Managament_of_tetanusprone_wounds/