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Pain Management Certificate
(Methoxyflurane) Learner Guide
Learner Guide
1
Acknowledgements
This education resource has been developed by the Australian Lifesaving Academy.
Surf Life Saving Australia (SLSA) would like to acknowledge the following people who contributed their time and expertise to support the development of this resource: Natalie Hood – National Medical Officer – Surf Life Saving Australia
Marcia Fife – State Emergency Care Advisor – Surf Life Saving Queensland
Stuart Wall – State Assessment Supervisor – Life Saving Victoria
Robert O’Brien – Resource Development Coordinator – Surf Life Saving Australia
SLSA would like to acknowledge the financial support it has received from the Federal Department of Education, Employment and Workplace Relations. The views expressed herein do not necessarily represent the views of the Commonwealth of Australia. The Commonwealth of Australia does not give any warranty or accept any liability in relation to the content of this work.
© Surf Life Saving Australia Ltd. This work is copyright, but permission is given to SLSA trainers and assessors to make copies for use within their own training environment. This permission does not extend to making copies for use outside the immediate training environment for which they are made, or the making of copies for hire or resale to third parties. For permission outside these guidelines, apply in writing to: Surf Life Saving Australia Locked Bag 1010, Roseberry NSW 2018 Ph: (02) 9215 8000 Fax: (02) 9215 8180 Web: www.sls.com.au All resources developed by Surf Life Saving Australia are reviewed at least annually and updated as required. Feedback can be supplied through the online Improvement Requests form on the Education Resources page at www.sls.com.au or in writing to the address above. Version 2.3 November 2012
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Contents
Acknowledgements .............................................................................................................................. 1
Course outcomes ............................................................................................................................. 3
Prerequisites .................................................................................................................................... 3
What you need to complete this course.......................................................................................... 3
Topic 1 - Pain and Analgesic Gases ..................................................................................................... 4
What is pain?.................................................................................................................................... 4
Measuring pain ................................................................................................................................ 4
Methoxyflurane ............................................................................................................................... 6
Penthrox Inhaler .............................................................................................................................. 6
Safety ............................................................................................................................................... 7
First Aid ............................................................................................................................................ 7
Topic 2 – Contraindications and Precautions ................................................................................... 10
Contraindications ........................................................................................................................... 10
Precautions .................................................................................................................................... 10
Casualty questioning ...................................................................................................................... 10
Assessing level of consciousness ................................................................................................... 11
Topic 3 – Administering Methoxyflurane ......................................................................................... 13
Administering methoxyflurane ...................................................................................................... 13
Self-administration ......................................................................................................................... 13
Procedure for administering methoxyflurane ............................................................................... 13
Special situations ........................................................................................................................... 16
Separation ...................................................................................................................................... 16
Hand-over to ambulance ............................................................................................................... 17
Topic 4 – Storage and Documentation ............................................................................................. 19
Storage ........................................................................................................................................... 19
Access ............................................................................................................................................. 19
Audit ............................................................................................................................................... 19
Disposal of drugs ............................................................................................................................ 19
Documentation .............................................................................................................................. 19
Casualty-specific documentation ................................................................................................... 20
Storage and supply documentation ............................................................................................... 20
Assessment Information .................................................................................................................... 22
Assessment Portfolio ........................................................................................................................... 1
Learner Guide
3
Course Introduction Many casualties treated by surf lifesavers and first aid teams experience severe pain due to the injuries sustained. A casualty suffering severe pain can focus on little else and is often uncooperative and unwilling to help the first aider apply timely and effective treatments.
Methoxyflurane is an inhaled analgesic (pain relief) that has been used by ambulance services in Australia for many years. It takes effect quickly and wears off equally as fast, with minimal side effects. These properties allow the gas to be used to more effectively treat casualties in severe pain by lessening the disruptive effects of the painful stimulus.
Course outcomes
By the end of this course you should be able to:
Detail the principles of pain management
Demonstrate basic pain management techniques
Detail the safety considerations and procedures for administering methoxyflurane
Administer methoxyflurane
Complete documentation involved in the use of methoxyflurane.
You will also develop knowledge and skills to enable you to demonstrate competency in the nationally recognised unit of competency:
PUAEME005A Provide Pain Management.
This unit forms a part of the nationally recognised qualification Certificate III in Public Safety (Aquatic Search and Rescue)
Prerequisites
To commence training for the Pain Management Certificate (Methoxyflurane) you must meet the following course prerequisites.
Be at least 18 years of age on the date of final assessment
Hold the SLSA awards :
o Apply (Senior) First Aid Certificate o Advanced Resuscitation Certificate OR Advanced Resuscitation Techniques Certificate
have achieved the following units of competency
o HLTFA211A Apply First Aid o HLTFA412A Apply advanced resuscitation techniques o PUAOPE010C Operate a semi automatic defibrillator in an emergency o PUAEME003C Administer oxygen in an emergency situation
What you need to complete this course
A copy of this learner guide
A copy of your State Operating Procedure relating to Methoxyflurane administration
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Topic 1 - Pain and Analgesic Gases
This topic will assist course participants in developing the skills and knowledge to:
Describe what pain is
Explain the principles of pain management
Explain how to quantify pain
Identify a methoxyflurane vial and Penthrox inhaler
Explain the mode of action
Explain the safety precautions of methoxyflurane use
What is pain?
Pain is a sensation, ranging from mild discomfort to agony. The sensation of pain may be localised or systemic (widespread) and is subjective (varies from person to person). It is caused by stimulation of pain receptors.
Nerve cells convey information from receptors in the extremities and organs of the body to the brain, where they are processed and perceived by the casualty as pain.
Pain often serves as a protective mechanism, as sudden pain initiates a reflex that causes muscle contraction, thereby moving the limb away from the painful stimulus (such as burns or treading on a nail).
Principles of pain management
A casualty suffering extreme pain can focus on little else and is often uncooperative and unwilling to help the first aider apply timely and effective treatment. A gentle but confident and professional approach to any casualty will build trust and make treatment administration easier.
Whether applying simple pain management methods such as ice, or formal pain management techniques discussed in this course, the principles are the same — relieve the casualty’s suffering, as you are unlikely to be able to stop the cause of the pain.
Basic pain management
Basic pain management techniques that may be appropriate according to the casualty’s injuries include:
Reassurance
Cold packs for local skin pain
Heat for penetrating marine creature injuries
Administration of methoxyflurane for severe pain.
Measuring pain
Measuring a casualty’s level of pain before and during administration of an analgesic is important to gauge the effectiveness of the treatment and is valuable information to pass on to paramedics.
Learner Guide
5
Verbal Numerical Rating Scale
This scale asks the casualty to rate their pain from “no pain” (0) to “worst pain possible” (10) and is suitable for use in adults and children over six years of age who have an understanding of the concepts of rank and order. Avoid using numbers on this scale to prevent the casualty receiving cues. Some casualties are unable to use this scale with only verbal instructions but may be able to look at a number scale and point to the number that describes the intensity of their pain.
Wong – Baker FACES Pain Rating Scale
This scale can be used with young children aged three years and older and may also be useful for adults and those from a non-English speaking background. Point to each face using the words provided to describe the pain intensity. Ask the child to choose face that best describes his/her own pain and record the appropriate number.
Figure 1.1 – Faces Pain Scale
From Wong D.L., Hockenberry-Eaton M., Wilson D., Winkelstein M.L., Schwartz P.: Wong's Essentials of Pediatric Nursing, ed. 6, St. Louis, 2001, p. 1301. Copyrighted by Mosby, Inc.
Analgesia
Analgesia is the relief of pain without the loss of consciousness. An analgesic is any of the drugs used to relieve pain and may more commonly be known as a pain killer. These work by:
blocking receptors in the central nervous system that receive pain signals
blocking transmission of pain signals along nerve pathways.
The SLSA policy regarding the use of analgesics can be found on the SLSA website www.slsa.com.au
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Methoxyflurane
The inhaled analgesic methoxyflurane can relieve discomfort, but will not completely eliminate pain. Methoxyflurane is an analgesic gas that is inhaled to provide pain relief. It comes in liquid form which vaporises at room temperature allowing inhalation by the casualty. The liquid is clear and colourless with a fruity odour.
Onset and washout
Pain relief from methoxyflurane (onset) occurs in two to three minutes and lasts four to five minutes once treatment has stopped (wash out).
Effective duration
Each 3 ml bottle of methoxyflurane will provide pain relief for 20-30 minutes.
Restricted drug classification
Methoxyflurane is a schedule 4 drug which means that it must be prescribed by a doctor. Surf lifesaving state organisations have approval for qualified members and employees to administer this drug following a protocol endorsed by the SLSA Medical Officer.
Identification
Methoxyflurane is produced in a 3 ml sealed amber glass bottle with a plastic wrap seal around the cap. It may be labelled as one of the following:
Methoxyflurane
Penthrox (brand name including inhaler device).
The methoxyflurane bottle and packaging will have a ‘Use by’ date. Never use methoxyflurane past this date, and never use bottles that have been tampered with (plastic wrap missing or damaged). These should be disposed of according to local authorities and replaced with fresh stock.
Figure 1.2 – Methoxyflurane vial
Penthrox Inhaler
The Penthrox Inhaler is a green cylinder designed to hold the methoxyflurane as it vaporises, to allow inhalation by the casualty. It is shown below with an activated carbon filter attached. The activated carbon filter is used to filter unused methoxyflurane from the air exhaled by the casualty, minimising exposure to the gas by the first aiders and bystanders.
Diutor
Mouthpiece
Figure 1.3 - Penthrox Inhaler with activated carbon filter attached
Activated carbon filter
Wrist strap
Learner Guide
7
Mode of action
The mode of action is how the analgesic works to provide pain relief. On inhalation, methoxyflurane passes easily into the blood across the respiratory membrane in the lungs, in a similar way to oxygen. Methoxyflurane acts directly on the central nervous system, blocking receptors to reduce the sensation of pain.
Side effects
nausea
vomiting
headache
Serious less common side effects can be:
profound respiratory and circulatory depression
loss of consciousness
Safety
Methoxyflurane is expelled from the casualty’s lungs in the same form as it is inhaled. The methoxyflurane exhaled by a casualty may be absorbed and have an effect on people nearby.
Frequent exposure to or large doses of methoxyflurane may be harmful to the kidneys, so it is essential that methoxyflurane is only used in well-ventilated areas to avoid first aiders being exposed to the gas.
To minimise exposure to methoxyflurane, an activated carbon filter should be used when administering to a casualty indoors.
Personal Protective Equipment (PPE)
When pouring methoxyflurane into the inhaler, the first aider should wear appropriate PPE (gloves
and eye protection) to minimise the chance of spilling methoxyflurane on his/her skin or splashing
in his/her eyes.
Methoxyflurane volatility
Methoxyflurane is a highly volatile liquid, which may ignite under relatively normal conditions. The
flashpoint (lowest temperature for vapour above a liquid to be ignited in air) of methoxyflurane is
62.8°C in air and 32.8°C when mixed with oxygen. It is important that the methoxyflurane bottle is
not left in direct sunlight. Methoxyflurane ignites easily and extra care should be taken when using
supplementary oxygen therapy, in the presence of naked flames or in other flammable situations.
First Aid
If accidental contact occurs, the following first aid treatments should be followed.
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Swallowed DO NOT INDUCE VOMITING. Rinse the mouth out with water and then give water to drink. Seek immediate medical assistance.
Eye Immediately irrigate with copious amounts of water for at least 15 minutes. Hold the eyelids open. In all cases of eye contamination it is a sensible precaution to seek medical attention.
Skin Wash contaminated skin with plenty of soap and water. Remove contaminated clothing and wash before re-use. If irritation occurs seek medical attention.
Individual Activity 1.1: Review Questions
Answer the questions below to review your understanding of this topic.
1. Where in the body is pain processed?
.......................................................................................................................
.......................................................................................................................
......................................................................................................................
2. What is the simplest method of measuring a casualty’s level of pain?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
3. Where can you find the surf lifesaving policy regarding the use of analgesic gases for pain management?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
4. Methoxyflurane is a ___________________ liquid with a __________________ odour.
5. Onset occurs in ___________________ and once treatment has stopped will last for ___________________
6. List (4) side effects of methoxyflurane treatment.
1......................................................................................................................2.....................................................................................................................3.....................................................................................................................4.....................................................................................................................
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7. What action should be taken if a casualty or carer swallows methoxyflurane?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
8. What should you do if methoxyflurane comes in contact with the eyes?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
9. When pouring methoxyflurane into the Penthrox inhaler it is recommended that you wear
___________________ and ___________________
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Topic 2 – Contraindications and Precautions
This topic will assist course participants in developing the skills and knowledge to:
Identify the contraindications for methoxyflurane
Explain how the use of methoxyflurane in the presence of contraindications will affect the casualty
Identify casualties for whom extra caution should be used when administering methoxyflurane
Contraindications
A contraindication is a reason not to use a course of treatment or a medication. Contraindications for administering methoxyflurane to a casualty include:
The casualty cannot understand or comply with the instructions for use.
The casualty has a history of kidney disease (renal impairment or renal failure), as methoxyflurane may cause kidney damage.
There is a decreased level of consciousness - Head injury or drug/alcohol induced (see Assessing Level of Consciousness on page 20).
The casualty has a known allergy to methoxyflurane.
There has been a severe allergic reaction to general anaesthetics in the casualty or the casualty’s family.
Casualties who have received methoxyflurane at any time in the past week.
Casualties with inadequate respiratory effort or rate.
Casualties suffering multi-trauma and shock.
Precautions
A precaution is a condition where caution is indicated but where the condition does not necessarily rule out the treatment or medication. Where casualties exhibit any of the following conditions, caution should be taken, paying particular attention to these conditions and stopping treatment if the first responder becomes concerned:
Respiratory depression, as it may worsen the condition
Cardiovascular instability, as it may worsen circulatory depression.
Casualty questioning
The best way to ensure that the casualty has no contraindications is to question him/her. Be certain that none of the above contraindications exists before starting treatment. Below are four key questions to ask when assessing the casualty for contraindications to methoxyflurane administration.
Questioning for Methoxyflurane Contraindications
(Kidney) Renal Impairment
‘Do you have or have you had significant medical problems affecting your kidneys?’
Allergy to Methoxyflurane
“Have you been administered methoxyflurane* in the past?’ If yes, ‘Did you have an allergic reaction to it?’
Learner Guide
11
Allergic Reaction to General Anaesthetics
‘Have you or anyone in your family had an allergic reaction to general anaesthetics?’
Recent Methoxyflurane use
‘Have you received methoxyflurane* in the past week?’
* An explanation that methoxyflurane is the pain relief given in the green inhaler (whistle) may assist the casualty in understanding if he/she has received methoxyflurane.
Assessing level of consciousness
A complication of methoxyflurane treatment is loss of consciousness, the danger of which is multiplied in casualties who already have a depressed level of consciousness. The casualty’s level of consciousness can be assessed using the AVPU Scale. The scale outlines four general levels of consciousness from Alert to Unconscious.
Alert
Voice: Responds to voice
Pain: Responds purposefully
Unconscious
Using the AVPU conscious state assessment, a casualty may receive methoxyflurane if he/she responds to voices and remains alert. People in the ‘Pain’ or ‘Unconscious’ categories are not candidates for methoxyflurane.
Alert
Eyes open
Speech clear
Moving
Orientated
Voice
Eyes open at request
Clear responses to questions
Moving
Remains awake/alert
Pain
Eyes open - pain stimulus
Casualty withdraws from pain
Comprehensible or non-comprehensible verbal noises
Unconscious
Does not meet above criteria
Maintain casualty airway
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Individual Activity 2.1: Review Questions
Answer the questions below to review your understanding of this topic.
1. Which of the following are contraindications for methoxyflurane therapy? (circle all correct answers):
a. The casualty is not accessible
b. The causalty has already received 6ml of methoxyflurane that day
c. The casualty is pregnant
d. The casualty does not understand the instructions
2. Name the scale commonly used to measure a casualty’s level of consciousness.
.......................................................................................................................
3. Fill the gaps in the AVPU consciousness level assessment.
A_____________
Voice: Responds to _____________
P____________: Responds purposefully
U____________
4. List two contradictions for methoxyflurane use.
1.....................................................................................................................
2.....................................................................................................................
5. What precaution should carers take if using methoxyflurane in any area with poor air circulation, including any confined space?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
Learner Guide
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Topic 3 – Administering Methoxyflurane
This topic will assist course participants in developing the skills and knowledge to:
Explain the treatment protocol for safely administering methoxyflurane to a casualty
Identify side effects associated with methoxyflurane use
Identify other considerations that need to be taken into account with methoxyflurane administration
Administering methoxyflurane
Methoxyflurane is self-administered by the casualty through an inhaler, which is disposable and for single use only.
Self-administration
Methoxyflurane is self-administered for two reasons. The first reason is that self-administration ensures that if the casualty loses consciousness the inhaler will fall away from the face and the casualty will inhale room air. Once the casualty stops inhaling they will quickly regain consciousness.
The second reason is that as the casualty is the best judge of their own pain, self-administration allows the casualty to control their pain. The casualty should be encouraged only to inhale methoxyflurane to achieve a more bearable level of pain.
Casualties with facial injuries may find the mouthpiece uncomfortable. In this situation the inhaler can be connected to a standard resuscitation mask. Casualties with facial or jaw injuries may not be able to tolerate either mask or mouthpiece. Always be sure you are not worsening an injury in your attempt to treat the casualty’s pain.
Procedure for administering methoxyflurane
1. Reassure the casualty.
2. Confirm indications for use (casualty is in pain).
3. Ascertain that there are no contraindications to methoxyflurane use.
4. Obtain methoxyflurane and check the expiry date and that the seal has not been tampered with.
5. Explain the procedure to the casualty
a) This is methoxyflurane, which will help relieve your pain
b) You must put the inhaler in your mouth while you breathe in
c) The gas will only be inhaled when u breathe in
d) Continue inhaling until the pain starts to dull. Aim for relief of discomfort rather than complete elimination of pain
e) If you feel any side effects, remove the inhaler. The unpleasant effects will wear off, but your pain will also worsen.
6. Ensure that the casualty understands the instructions for use.
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7. Prepare the inhaler for use:
a) Insert the activated Carbon device into the diluter hole
b) Hold the inhaler upright with the mouthpiece down. Open the vial and p[our the full 3ml into the base cap. Shake gently and wipe the mouthpiece.
8. Pass the inhaler to the casualty and allow him/her to breathe through the inhaler.
9. After the casualty has taken 8-10 breaths, he/she can be instructed to place a finger over the diluter hole to increase the concentration of methoxyflurane being inhaled.
Learner Guide
15
10. Instrust the casualty to inhale the methoxyflurane intermittently but sufficiently to provide adequate pain relief.
Methoxyflurane given intermittently
Figure 2.1: Example of intermittent inhalation of methoxyflurane to provide pain relief.
11. Fasten the strap of the inhaler to the
casualty’s wrist.
12. Upon starting treatment record the following:
a) In the ‘Drug Register’
(i) date, casualty’s full name, date of birth
(ii) time therapy started
b) On the ‘Medical Response Form’
(i) time therapy started
13. When a satisfactory level of pain relief is achieved, check the level of consciousness by giving the casualty a simple command (e.g. lift your left arm, squeeze my hand, wiggle your toes). Continually assess the casualty’s level of consciousness while methoxyflurane is being inhaled.
0 20 40 60 80
100 120
1 4 7 10 13 16 19 22 25 28
% 0
f seru
m l
evel
Minutes
Penthrox given intermittently Pain Relief
6 breaths 6 breaths 6 breaths
Pain Management Certificate
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14. At the end of treatment, record the following:
a) In the ‘Drug Register’
(i) time therapy stopped
b) On the ‘Medical Response Form’
(i) time therapy stopped
(ii) total inhalation time
15. If the first dose of methoxyflurane runs
out, a second vial can be used. The total dose
administered must not exceed 6 ml (i.e. two vials maximum).
NOTE: A second Methoxyflurane unit will need to be opened
if a second vial is required
16. As soon as methoxyflurane treatment is stopped, place the casualty on oxygen therapy for at least three minutes.
17. Ensure a completed copy of the ‘Medical Response Form’ goes to the hospital with the casualty.
18. Participate in an operational debrief. This debrief may be performed with your supervisor, or by an external counselling support network.
Remember this!
The maximum dose of methoxyflurane to be given to a casualty in a 24 hour period is 6 ml (two vials)
Special situations
Inaccessible patient
Where a casualty cannot be reached by the first aider, but is communicating, can understand instructions and can be visually monitored by the first aider, load the inhaler and pass/throw it to the casualty.
NOTE: The Penthrox inhaler is single use only and must be discarded safely after use. The patient is likely to be still using the device when transported by the ambulance service to the hospital, so the device can be discarded in accordance with hospital protocols.
Separation
Casualties treated with methoxyflurane must not be allowed to leave the treatment site without further medical follow-up. Generally the nature of the injury or illness will require further medical aid. The casualty should be transported to hospital by ambulance.
Learner Guide
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If the casualty refuses further medical aid:
the casualty must sign a “Medical Treatment Waiver”
you must advise the casualty not to drive or operate dangerous machinery for 24 hours
Hand-over to ambulance
State that the casualty has been given methoxyflurane
Provide completed Medical Response Form and verbal information
o casualty's name o age o nature of injury o treatment of injury o methoxyflurane has been given o casualty’s condition since commencing treatment o side effects
Individual Activity 3.1: Review Questions
Answer the questions below to review your understanding of this topic.
1. How can the casualty increase the concentration of methoxyflurane that he/she is inhaling? (please circle the correct answer)
a. By breathing faster
b. By blocking the diluter hole with the finger
c. Both of the above
d. The dose cannot be changed
2. What is the maximum daily dose of methoxyflurane?
.......................................................................................................................
3. Put the following steps into the order that they would be performed:
- Explain procedure to the casualty
- Decant the methoxyflurane into the inhaler device
- Reassure the casualty
- Monitor the casualty
- Check for contraindications
- Confirm that the casualty is in need of pain relief
4. What form must be sent to the hospital with the casualty?
.......................................................................................................................
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5. List two reasons why it is important to have the casualty self-administer methoxyflurane
1.....................................................................................................................
.......................................................................................................................
2.....................................................................................................................
.......................................................................................................................
6. If the casualty recovers from their initial injury after having been administered methoxyflurane, are they allowed to leave your care and be looked after by family members or friends? (please circle correct answer)
Yes / No
7. What might you do if the casualty is unable to tolerate the mouthpiece of the inhaler?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
Learner Guide
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Topic 4 – Storage and Documentation
This topic will assist course participants in developing the skills and knowledge to:
Identify the forms to be filled in when methoxyflurane is used
Complete the Medical Response Form when methoxyflurane is used
Complete logs according to Surf Life Saving Australia and specific State/Territory procedures
Storage
As methoxyflurane is a schedule 4 drug that has a restricted supply due to the possibility of misuse, it is required that it be securely stored. Secure storage generally requires that the drug be stored in a locked cabinet (either key or keypad entry) that is difficult to move, either because it is fixed to a wall or because of its weight. It is important that the methoxyflurane is always returned to the secure storage supplied at your club or service when not in immediate use.
Access
Access to the storage cabinets is allocated based on need to authorised and qualified personnel. This is to limit the amount of opportunity for abuse. While procedures may vary from state to state, the general principle is that if you are issued access (either key or code) it is for your personal use and you should not give your key or access code to anyone else. Should someone else require access using your key for a legitimate reason you should supervise the access and ensure the drug register and any additional documentation is correctly filled out. When you no longer require a key, it should be returned to the issuing authority.
Audit
As a requirement of being authorised to store and administer methoxyflurane, surf lifesaving services are required to audit their stocks of methoxyflurane and related records. This auditing is usually done by one or two independent auditors appointed by the relevant surf lifesaving state headquarters.
Disposal of drugs
All drug bottles requiring disposal are to be disposed of in accordance with your relevant State or Territory guidelines. This may include:
Out of date bottles
Damaged bottles
Used or empty bottles (some states may require the return of used bottles as a part of the tracking process).
Documentation
There is special documentation associated with the use of methoxyflurane, additional to the standard forms required for first aid treatment. These special forms are to meet the following requirements:
for accurate handover of casualty treatment
for tracking storage and use of the drug
to provide legal coverage.
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Records of the receipt and disposition of the inhalers are to be made in such a manner that stocks are accountable and that any diversion or inappropriate use is minimal and detectable. Such records are to be retained for twelve months from the date of the last entry.
Casualty-specific documentation
Medical Response Form
When a casualty is passed from the care of the first aider to another service it is always important that information about the casualty’s history and treatment is communicated to the receiving personnel to ensure best casualty care. When the use of a drug has been included in the treatment it becomes essential that accurate information is handed over in a written form. The Medical Response Form captures all of the relevant data for hand over of a casualty who has been administered methoxyflurane.
Treatment Waiver Form
Casualties treated with methoxyflurane must not be allowed to leave the treatment site without further medical follow-up (usually ambulance). If a casualty refuses to wait for the medical follow-up he/she must be asked to sign a Medical Treatment Waiver to acknowledge that he/she is leaving against advice. This form is to provide legal coverage for the first aider should the casualty suffer adverse reactions after leaving care.
Storage and supply documentation
Depending on specific state procedures there may be further documentation required regarding the storage and supply of methoxyflurane. The drug register is standard documentation required in all states.
Drug Register
First Aiders will be required to fill out the drug register that is stored with the drugs in the locked cabinet at the club or service. This should be filled out whenever drugs are removed from or placed into the storage cabinet. The purpose of the drug register is so that stocks can be accounted for and any diversion or inappropriate use is minimal and detectable. All transactions involving the addition or removal of the drugs must be logged and may include:
removing drugs for use in treating a casualty
returning excess drugs not used in treating a casualty
removing out of date drugs to send to state headquarters for disposal
receiving new supplies from state headquarters.
Individual Activity 4.1: Review Questions
Answer the questions below to review your understanding of this topic.
1. What are your State’s reporting obligations governing the use of methoxyflurane?
Learner Guide
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.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
2. What forms must be completed in addition to standard first aid logs when methoxyflurane is used?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
3. What information needs to be recorded on a Medical Response Form?
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
4. What information needs to be recorded on a Medical Treatment Waiver?
.......................................................................................................................
.......................................................................................................................
......................................................................................
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Assessment Information
Following is a description of the assessment tasks required to demonstrate competence in this course. This section is for information only. All evidence should be collected in the assessment portfolio section of this Learner Guide.
There are six assessment tasks to be completed for the Pain Management Certificate (Methoxyflurane) Course.
Task 1: Written questions
Task 2: Demonstration of pre-administration checks
Task 3: Demonstration of equipment set-up: Penthrox Inhaler
Task 4: Demonstration of administration procedures: Penthrox Inhaler
Task 5: Demonstration of post-administration procedures: Penthrox Inhaler
Task 6: Scenario
Assessment Task 1: Written Questions
You will be assessed on your understanding of pain management and the administration of methoxyflurane through a multiple choice theory assessment. All questions are based on information found in SLSA policies and this Learner Guide. The question paper is in the assessment portfolio section of this Learner Guide. Please write all answers on the sheet provided in the assessment portfolio section of this Learner Guide.
Assessment Tasks 2, 3, 4 & 5: Demonstrations of pre-administration checks; equipment set-up; administration procedures and post-administration procedures.
You will be required to perform four demonstrations. Demonstrations may be combined where it will be more efficient and logical.
Your Facilitator or Assessor will assess you against the criteria outlined below:
Pre-administration
DRSABCD
Reassure the casualty
Recognise the need for methoxyflurane
Ascertain that there are no contraindications for use
Explain the procedure to the casualty
Ensure that the casualty understands the instructions for use
Retrieve correct drug and check the expiry date on the vial and packaging
Assessment Task 3: Demonstration of equipment set-up: Penthrox Inhaler
Equipment setup
Inhaler held correctly
Inhaler loaded
Learner Guide
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Inhaler gently shaken to dispel excess fluid
Mouth piece wiped
Administration
The casualty is instructed to use inhaler correctly
The casualty is instructed to inhale intermittently
The strap is gently fastened to the casualty’s wrist
The following information is recorded on the Medical Response Form:
Date, casualty’s full name, date of birth
Indication for treatment
Time therapy commenced
The casualty’s level of consciousness is continuously monitored
A second vial is loaded, if necessary
Post-administration
Record the time that treatment ceased
The casualty is placed on oxygen therapy
Relevant logs and documentation completed
Hand over the casualty to ambulance personnel
Unused drugs are disposed of appropriately
Assessment Task 6: Scenario
You will be assessed, in a scenario, on how well you deal with an incident that will require you to manage a casualty’s pain. The scenario will be made as real as possible and will be in line with the training and the association’s standards and policies.
After each scenario the group will discuss the outcomes of the incidents with the Assessors. This is to assess everyone’s ability to apply the skills and knowledge in a patrol situation.
Your Facilitator or Assessor will assess you against the criteria outlined below:
Scenario
DRSABCD
Control/manage the situation
Obtain information on the casualty’s injury
Recognise the need for methoxyflurane
Assess for contraindications
Retrieve correct drug and check it is within expiry date
Explain the procedure to the casualty
Load the inhaler
Safely administer Methoxyflurane
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Assess the casualty’s level of consciousness / vital signs
Continuously monitor the casualty
Respond to adverse effects
Complete a Medical Response Form
Hand over the casualty to ambulance personnel
Dispose of unused Methoxyflurane appropriately
Complete appropriate documentation
Debriefing/evaluation of treatment is completed with peers/assessor
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Assessment Portfolio
This portfolio details all the evidence you are required to submit to your Assessor to
demonstrate competence in the Pain Management Certificate (Methoxyflurane).
Learner Details
First Name: Surname:
Date of Birth: Club / Group:
Competency Record
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Pain Management Certificate (Methoxyflurane)
Assessment Tasks
Task 1: Written questions completed
Task 2: Demonstration of pre-administration checks
Task 3: Demonstration of equipment set-up: Penthrox Inhaler
Task 4: Demonstration of administration procedures: Penthrox Inhaler
Task 5: Demonstration of post-administration procedures: Penthrox Inhaler
Task 6: Scenario
Nationally Recognised Unit of Competency
PUAEME005A Provide Pain Management
Assessor Name:
Assessor Signature: Date:
Assessment Task 1: Written questions
This is a question paper only
Do not mark this paper. Use the ANSWER SHEET provided in the assessment portfolio section of your Learner Guide.
Read each question carefully before circling the correct answer on the answer sheet.
Please return this paper to the Assessor at the end of the assessment with your completed answer sheet.
Pass mark
85% (17+ out of 20 correct) – Proceed to the next section of the assessment. Your assessor will discuss any incorrect answers with you.
Less than 85% correct - Unable to proceed any further. Your assessor will discuss a resit time with you.
Please speak to your assessor if you believe that you may have a learning difficulty that affects your ability to answer these questions.
All questions relate to information contained in the Pain Management Certificate (Methoxyflurane) Learner Guide
1. How can pain serve as a protective mechanism?
a. by initiating a reflex that moves the limb away from painful stimulus
b. by sending information from organs to the brain
c. by being systemic (widespread) or localised
d. by causing general muscle contractions
2. Methoxyflurane is a
a. clear liquid with no odour
b. clear liquid with a fruity odour
c. dark liquid
d. clear liquid with a bitter taste
3. Onset of action occurs
a. in 5-6 minutes
b. instantly
c. in 30 seconds
d. in 2-3 minutes
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1
4. Once treatment has stopped pain relief will last for
a. 4-5 minutes
b. 6-7 minutes
c. 2-3 minutes
d. 7-8 minutes
5. What action should be taken if a casualty or carer swallows methoxyflurane?
a. induce vomiting
b. give large amounts of milk to drink
c. do not induce vomiting, rinse mouth then give water to drink and seek medical assistance
b. no harm will come to someone who swallows methoxyflurane
6. What should you do if methoxyflurane comes in contact with the eyes?
a. cover both eyes with pads
b. hold the upper lid over the lower lid and get the casualty to blink
c. pad the eye
d. flush the area with water for 15 minutes, seek medical advice
7. Methoxyflurane must not be administered if the
a. casualty has flushed red skin
b. casualty has cold clammy skin
c. casualty does not understand instructions
d. casualty is not accessible
8. Name the scale commonly used to measure a casualty’s level of consciousness
Course Feedback Form
a. Unconscious scale
b. Carol’s coma scale
c. AVPU scale
d. Richards response scale
9. Which of the following is contraindication for methoxyflurane therapy?
a. broken ankle
b. severe abdominal pain
c. history of kidney disease
d. b and c
10. What precaution should carers follow if using methoxyflurane in a confined space?
a. use an activated carbon filter
b. stay with the casualty
c. do not use in confined spaces
d. both b and c
11. When pouring methoxyflurane into the Penthrox inhaler it is recommended that you
a. wear gloves
b. wear safety glasses
c. do it quickly
d. both a and b
12. How can the casualty increase the concentration of methoxyflurane that they are inhaling?
a. by breathing faster
b. by covering the diluter hole with their finger
c. both a and b
d. the dose cannot be changed
13. What is the maximum dose of methoxyflurane in 24 hours?
a. 3 ml
b. 9 ml
c. 6 ml
d. 12 ml
14. What form must be sent to hospital with the casualty?
a. no forms need to be sent
b. IRD
c. medical response form
d. patrol log
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15. It is important that methoxyflurane be
a. administered by the first aider
b. self-administered
c. administered by family or a friend
d. held into the mouth of the casualty
16. Common side effects include
a. Nausea
b. vomiting
c. drowsiness
d. all of the above
17. If a casualty recovers from his/her initial injury he/she should
a. stay in your care until medical assistance arrives
b. be left in the care of friends or family
c. be left on his/her own to recover
d. be instructed to get himself/herself to hospital
18. Currently, all green Penthrox inhalers are
a. easily cleaned and reused
b. biodegradable
c. hypoallergenic
d. single use only
19. Which statement below is most true when considering if a casualty is suitable to receive treatment with methoxyflurane?
a. No considerations need to be made if a casualty has a history of kidney disease
b. A casualty who has received methoxyflurane in the previous three months cannot receive it again
c. A casualty who is suffering from shock should not receive methoxyflurane
d. It is acceptable to give a casualty with a personal or family history of allergic reactions anaesthetics methoxyflurane as they are different from analgesics.
20. What paperwork must be completed relating to an incident where methoxyflurane has been administered to a casualty?
a. Medical Response Form
b. Drug Register
c. Incident Report Form
d. All of the above
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Assessment Task 1: Written Questions – Answer Sheet
Please mark all answers on this sheet.
NAME:
________________________________________________
a. b. c. d. 11. a. b. c. d.
a. b. c. d. 12. a. b. c. d.
a. b. c. d. 13. a. b. c. d
a. b. c. d. 14. a. b. c. d.
a. b. c. d. 15. a. b. c. d.
a. b. c. d. 16. a. b. c. d.
a. b. c. d. 17. a. b. c. d.
a. b. c. d. 18. a. b. c. d.
a. b. c. d. 19. a. b. c. d.
a. b. c. d. 20. a. b. c. d.
Assessment Portfolio
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Course date: ______________ Location: ______________ Your name: ______________
(Optional)
Trainer(s) and Assessor(s): ______________________________________________________
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