Pediatric Pain Control

 

History:

 

  • Age
  • Location
  • Duration
  • Severity (1-10 or Wong-Baker faces scale)
  • Past medical history
  • Medications

 

Significant Findings:

 

  • Severity (pain scale)
  • Quality (sharp/dull/etc.)
  • Radiation
  • Relation to movement
  • Respiration
  • Increase with palpation of area

 

Differential:

 

  • Musculoskeletal
  • Head trauma
  • Visceral (abdominal)
  • Cardiac
  • Pleural/respiratory
  • Neurogenic
  • Renal (colic)

 

  • Severe pain from
    • extremity injuries
    • burns
    • hip injuries
    • sickle cell crisis, etc.

 

Treatment:

 

 

 

  • Oxygen

 

  • Pulse Oximetry

 

 

 

  • Initiate IV, INT not acceptable

 

Age appropriate B/P (see PEARLS) ?

 

  • No

 

 

 

 

  • Yes

 

 

 

 

  • Must reassess patient at least every 15 minutes after sedative medication

 

 

 

 

 

Improvement ?

 

  • Yes

 

    • Notify receiving facility or contact Medical Control

 

  • No

 

 

 

  • If after 10 min SBP >90 and patient is still in moderate to severe pain or obvious discomfort, request Morphine 0.05 mg/kg IV/IM

 

  • Must reassess patient at least every 15 minutes after sedative medication

 

PEARLS:

 

  • Pediatric = 1 day to less than age 12, or less than 55 kg in ages 13-18.
  • Use Broselow tape for drug dosages.
  • Pain severity (0-10) is a vital sign to be recorded pre, and 15 min post, medication delivery, and at disposition.

Age based hypotension:

    • less than 1 year:
      • less than 70 SBP
    • 1-10 years:
      • less than 70 + (2 x age) SBP
    • greater than 11:
      • less than 90 + (2 x age) SBP

 

  • Zofran (Ondansetron) can cause QT widening.
  • Contraindications to narcotic use include:
    • hypotension
    • head injury
    • respiratory distress
    • severe COPD.
  • 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.
  • All patients receiving prehospital narcotic analgesic or benzodiazepines should have:
    • continuous pulse oximetry monitoring
    • EKG
    • and non- invasive capnography (if available)
  •   All patients 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.

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRP

National Registry Paramedic

NRP

National Registry Paramedic