Morphine Sulphate 10mg/ml Levomepromazine 25mg/ml Midazolam 10mg/2ml Hyoscine Butylbromide 20mg/ml Drug sensitivities: ……………………………………………………….. Water for injection 20ml Drug allergies: ……………………………………………………………. Pain, cough or OPIOID SC 2 hourly 6 doses in 24 hours Breathlessness Nausea/Vomiting 3.125mg - 25mg total prn in 24 Levomepromazine SC 2 hourly Agitated Delirium hours Anxiety Breathlessness Midazolam 2.5mg 5mg SC 2 hourly 4 doses in 24 hours (2nd line) Respiratory If effective for Hyoscine secretions / 10mg - 20mg SC 2 hourly secretions consider Butylbromide starting syringe driver Abdominal colic Nausea/Vomiting Pain, Respiratory Anxiety cough or SC SC SC SC SC Agitated Breathlessness Breathlessness secretions Delirium / Abdominal (2nd line) colic
Morphine Sulphate 10mg/ml Levomepromazine 25mg/ml Midazolam 10mg/2ml Hyoscine Butylbromide 20mg/ml Water for injection 20ml Drug sensitivities: ……………………………………………………….. Drug allergies: ……………………………………………………………. Pain, cough or Breathlessness OPIOID SC 2 hourly 6 doses in 24 hours Nausea/Vomiting Agitated Delirium Levomepromazine 3.125mg SC 2 hourly 25mg total prn in 24 hours Anxiety Breathlessness (2nd line) Midazolam 2.5mg - 5mg SC 2 hourly 4 doses in 24 hours Respiratory secretions / Abdominal colic Hyoscine Butylbromide 10mg - 20mg SC 2 hourly If effective for secretions consider starting syringe driver Pain, cough or Breathlessness SC Nausea/Vomiting Agitated Delirium SC Anxiety Breathlessness (2nd line) SC Respiratory secretions / Abdominal colic SC SC
Approved-CD1-form-Mar-2018.docx