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  <head>
    <title>061-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Pain, analgesia, anaesthesia, and sedation safety">
      <outline text="Orientation">
        <outline text="Pain protective, disabling when persistent"/>
        <outline text="Analgesia preserves breathing, circulation, cognition"/>
        <outline text="Anaesthesia and sedation alter consciousness and reflexes">
          <outline text="Rapid airway and haemodynamic emergencies"/>
        </outline>
        <outline text="Safe care: mechanism, consent, monitoring, rescue"/>
      </outline>
      <outline text="Pain mechanisms and assessment">
        <outline text="Nociceptors detect mechanical, thermal, chemical threat"/>
        <outline text="Spinal cord amplifies or inhibits signals">
          <outline text="Ascends through thalamic and cortical networks"/>
        </outline>
        <outline text="Descending pathways, fear, mood, sleep modulate"/>
        <outline text="Real without visible damage, description not mechanism"/>
        <outline text="Nociceptive: somatic or visceral tissue injury"/>
        <outline text="Neuropathic: somatosensory lesion or disease">
          <outline text="Burning, electric, shooting, numb, allodynic"/>
        </outline>
        <outline text="Nociplastic: altered processing without lesion"/>
        <outline text="Mixed in cancer, back pain, diabetes, trauma"/>
        <outline text="Scale suited to communication, not replacing function"/>
        <outline text="Impaired communication: behaviour, caregivers, trials"/>
      </outline>
      <outline text="Multimodal analgesia">
        <outline text="Treat cause, combine different pathways"/>
        <outline text="Positioning, splinting, physiotherapy, psychology"/>
        <outline text="Regional anaesthesia is opioid-sparing"/>
        <outline text="Paracetamol: analgesia, antipyresis, little anti-inflammation">
          <outline text="Check total dose across combination products"/>
          <outline text="Overdose causes silent early hepatic injury"/>
        </outline>
        <outline text="NSAIDs inhibit cyclooxygenase and prostaglandins">
          <outline text="Ulcer, bleeding, kidney injury, sodium retention"/>
          <outline text="Risk: age, dehydration, anticoagulation, heart failure"/>
          <outline text="Lowest dose, shortest time, topical for local pain"/>
        </outline>
      </outline>
      <outline text="Opioids">
        <outline text="Receptors reduce transmitter release and excitability"/>
        <outline text="Sedation, respiratory depression, constipation, itch"/>
        <outline text="Risk: sleep apnoea, frailty, naivety, co-sedatives"/>
        <outline text="Small monitored intravenous doses for rapid effect"/>
        <outline text="Oral treatment safer for stable pain"/>
        <outline text="Equianalgesic tables estimate, cross-tolerance incomplete">
          <outline text="Reduce calculated dose when rotating"/>
        </outline>
        <outline text="Long-acting unsuitable for naive rapid titration"/>
        <outline text="Respiratory depression: rate, depth, arousal fall">
          <outline text="Oxygen keeps saturation deceptively normal"/>
          <outline text="Stimulate, airway, ventilate, titrate naloxone"/>
          <outline text="Naloxone may wear off first"/>
        </outline>
        <outline text="Chronic pain: functional goals, benefit over harm">
          <outline text="Higher doses increase overdose, not function"/>
        </outline>
        <outline text="Dependence adaptation, addiction impaired control">
          <outline text="Avoid abrupt discontinuation"/>
        </outline>
      </outline>
      <outline text="Neuropathic and specialised analgesia">
        <outline text="Antidepressants, gabapentinoids, lidocaine, capsaicin">
          <outline text="Start low, review falls and sedation"/>
        </outline>
        <outline text="Ketamine">
          <outline text="N-methyl-D-aspartate receptor antagonist"/>
          <outline text="Analgesia with relative preservation of breathing"/>
          <outline text="Dissociation, hypertension, emergence phenomena"/>
        </outline>
        <outline text="Local anaesthetics block sodium channels">
          <outline text="Toxicity: circumoral, tinnitus, seizure, dysrhythmia"/>
          <outline text="Stop, airway, modified resuscitation, lipid emulsion"/>
        </outline>
        <outline text="Cancer pain: disease-directed and multimodal care">
          <outline text="Incident pain needs pre-emptive rescue dosing"/>
        </outline>
      </outline>
      <outline text="Pre-anaesthetic assessment">
        <outline text="Procedure, urgency, airway, reflux, fasting, frailty"/>
        <outline text="Records: difficult airway, malignant hyperthermia"/>
        <outline text="No single test predicts airway difficulty">
          <outline text="Prepare up to front-of-neck rescue"/>
        </outline>
        <outline text="Test only when results change care"/>
        <outline text="Optimise without delaying emergency surgery"/>
        <outline text="Excessive fasting causes dehydration"/>
        <outline text="Delayed gastric emptying, fasted patients aspirate"/>
      </outline>
      <outline text="General and regional anaesthesia">
        <outline text="Hypnosis, amnesia, analgesia, immobility, reflexes"/>
        <outline text="Agents reduce sympathetic tone, resistance, breathing"/>
        <outline text="Monitoring guides dosing and detects failure"/>
        <outline text="Preoxygenation extends safe apnoea time"/>
        <outline text="Confirm tube by sustained exhaled carbon dioxide"/>
        <outline text="Failed oxygenation: oxygen before repeated attempts"/>
        <outline text="Neuraxial blocks nerve roots and sympathetic outflow">
          <outline text="Hypotension, retention, headache, high block"/>
          <outline text="Antithrombotic timing prevents spinal haematoma"/>
        </outline>
        <outline text="Peripheral blocks: dose, monitoring, protect limb"/>
      </outline>
      <outline text="Procedural sedation">
        <outline text="Continuum from anxiolysis to unresponsiveness"/>
        <outline text="Rescue one level deeper than intended"/>
        <outline text="Dedicated monitoring clinician for deeper sedation"/>
        <outline text="Prepare oxygen, suction, bag-mask, reversal"/>
        <outline text="Capnography detects hypoventilation before desaturation"/>
        <outline text="Benzodiazepine plus opioid synergistically depress"/>
        <outline text="Propofol: apnoea, hypotension, no reversal"/>
        <outline text="Ketamine preserves reflexes, laryngospasm possible"/>
        <outline text="Nitrous oxide expands closed gas spaces"/>
      </outline>
      <outline text="Emergencies and recovery">
        <outline text="Anaphylaxis without rash: give adrenaline"/>
        <outline text="Malignant hyperthermia: carbon dioxide, rigidity, heat">
          <outline text="Stop triggers, dantrolene, cool"/>
        </outline>
        <outline text="Awareness: take reports seriously, support"/>
        <outline text="Hypothermia raises bleeding and infection"/>
        <outline text="Recovery: stable airway, circulation, consciousness"/>
        <outline text="Discharge: escort, written advice, restrictions"/>
      </outline>
    </outline>
  </body>
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