Do children tolerate pain better than adults
no, pain tolerance increases with age.
What does QUESTT stand for? this is to assist in remembering components of pain management.
Question the child Use pain rating scales Evaluate behavior Secure parent’s involvement Take cause of pain into account Take action and evaluate results
What does the ABCDE approach of pain management stand for
Ask about pain and assess systematically Believe patient and family Choose appropriate pain-control options Deliver interventions in timely, logical, and coordinated fashion Empower or enable patient and family
What is most important about pain assessment tools
use the same one consistently
Three possible meds for neuropathic pain?
gabapentin, carbamazepine, pregalban
Downsides of PRN dosing?
peaks and valleys, leads to undermedication, (by the clock is better), decreases trust with HCP,
What is pseudoaddiction?
Pseudoaddiction is distress and drug seeking that can occur in the context of unrelieved pain, such as similar behaviors in addicts. The main factor of this syndrome is that sufficient pain relief eliminates aberrant behavior, especially seen in the sickle cell population.
big emphasis in slides on phys dependence vs addiction, implying that HCPs are overly cautious about addiction in children and should prescribe opiods for pain mgmt as necessary
When to give IM pain meds
no need to ever give it. subQ may be acceptable in rare cases but usually not necessary
requirement for meds given via epidural
preservative free solution to prevent CNS irritation
What is associated with meperidine
rigors. not good pain control, works better for providing euphoria.
When to taper opiods
if used for 1-3 weeks or longer, usually at 10-20% every other day
Do not use this as pain management with sickle cell patients
cold - can worsen pain crisis
What to do prior to a tricyclic antidepressant, such as amitriptyline?
EKG to rule out prolonged QT
Onset of fentanyl? lasts?
less than 1 m, lasts 30-45 min
Onset of IV hydromorphone? how long does it last
rapid onset but lasts 4-6 h
What is the key to successful EOL care
acetaminophen and codein dose
0.5-1 mg/kg per dose PO 4-6 h
Fentanyl pediatric vs adult dose
Peds .06 mg/kg q3-4h
Adult 7.5 mg q3-4 h
for IV .01-.02 IV q2h
0.1-0.2 mg/kg per PO q4-6h
How much more potent is hydromorphone (dilaudid) than morphine
5 times more