Pediatric Pain Management
- Severity (1-10 or Wong-Baker faces scale)
- Past medical history
- Drug allergies
- Severity (pain scale)
- Quality (sharp/dull/etc.)
- Relation to movement
- Increase with palpation of area
- Per the specific protocol
- Visceral (abdominal)
- Initiate IV, INT not acceptable
- Full set of vital signs including SAO2
- Toradol 0.5 mg/kg, Max 15 mg IV, 30 mg IM
- Fentanyl 1 mcg/kg slow IV/IO/IM/IN up to 50 mcg; May repeat once in 5 minutes. Max dose of 100 mcg * Ages ≥ 5 years old ONLY.
- Must reassess patient at least every 5 minutes after sedative medication
- Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
- Toradol restricted to patients 2 years of age of older.
- OLMC is required for Morphine, Fentanyl, and Nitrous Oxide for ages < 5 years old.
- Pain severity (0-10) is a vital sign to be recorded pre, and 5 min post, medication delivery, and at disposition with all pain medications.
Age based hypotension:
less than 1 year:
- less than 70 + (2 x age) SBP
greater than 11:
- less than 90 + (2 x age) SBP
- Zofran (Ondansetron) can cause QT widening. 8-15 kg: Zofran 2 mg IV/IO/IM, > 15 kg 4 mg IV/IO/IM
Contraindications to narcotic use
- head injury
- respiratory distress
- Contraindictations to Toradol include active bleed (including ulcer and GI) renal disease, possible surgery.
- All patients should have drug allergies documented and avoid medications with a history of an allergy or reaction.
- Assess for significant head trauma or GCS less than 13. If present, withhold pain management.
- Maximize the use of non-pharmaceutical pain management techniques (e.g., positioning, padding and splinting, reassurance, heat/cold therapy, etc.) whenever possible.
receiving prehospital narcotic analgesic or benzodiazepines should have:
- continuous pulse oximetry monitoring
- EKG and non- invasive capnography (if available)
who receive IM or IV medications
- must be observed 15 minutes for drug reaction.
- Stop Morphine administration if significant adverse effects (severe nausea, vomiting, signs of poor perfusion, respiratory depression) or sedation (decreased mental status) develop.
- Respiratory depression should be treated with Oxygen and ventilatory support if necessary.
- Attempt verbal and tactile stimulation to reverse respiratory depression prior to considering Naloxone (Narcan).
- Administer the smallest possible reversal dose of Naloxone (Narcan) to maintain adequate respirations.