Pediatric Pain Management

Question 1

Pediatric Pain Management - Normotensive pain control medications

Answer 1

Fentanyl IV/IM/IO - 1 mcg/kg single max of 50 mcg
Fentanyl IN - 2 mcg/kg single max of 100 mcg
Morphine IV/IM/IO - 0.1 mg/kg single max of 5 mg

Question 2

Pediatric Pain Management - Hypotensive pain control treatment

Answer 2

Treat concurrently with shock protocol
Mandatory OLMC
Ketamine 0.2 mg/kg

Question 3

Pediatric Pain Management - Nitrous Oxide indication

Answer 3

Pain

Question 4

Pediatric Pain Management - Nitrous Oxide dose

Answer 4

Self-administered

prn

Question 5

Pediatric Pain Management - Nitrous oxide EMS contraindiations

Answer 5

Inability to follow verbal instructions
Intoxication with alcohol or drugs
Head injury with altered mental status
Thoracic injury suspicious for pneumothorax 
Abdominal pain

Question 6

Pediatric Pain Management - Nitrous oxide precautions

Answer 6

Invert canister three times prior to administration

Administer early while obtaining vascular access to provide pain relief prior to narcotic administration

Question 7

Pediatric Pain Management - Morphine indications

Answer 7

Pain

Question 8

Pediatric Pain Management - Morphine loading dose

Answer 8

0.1 mg/kg SIVP/IM/IO single max of 5 mg

q 5 min prn total max of 15 mg

Question 9

Pediatric Pain Management - Morphine maintenance dose

Answer 9

0.1 mg/kg SIVP/IM/IO q 10 min prn, max single dose of 5mg, to a total max of 0.1mg/kg per hour
Maintenance dose time starts after loading dose administered

Question 10

Pediatric Pain Management - Morphine EMS contraindications

Answer 10

Hypersensitivity

Systolic BP less than 70 + (2 x age) mmHg

Question 11

Pediatric Pain Management - Morphine precautions

Answer 11

Use cautiously if evidence of ETOH or drug intoxication
May cause respiratory depression and hypotension; monitor vital signs closely post administration
Use with caution with other drugs that are sedatives / depressants

Question 12

Pediatric Pain Management - Morphine administration for patients > 10 kg

Answer 12

Consider diluting to the concentration of 1 mg/mL with 9 mL of normal saline in a 10 mL syringe. Waste up to the 1 time dose that is being administered.

Question 13

Pediatric Pain Management - Morphine administration for patients < 10 kg

Answer 13

draw up 1 ml of 10 mg/mL morphine in a 1 mL syringe and waste up to the 1 time dose that is being administered

Question 14

Pediatric Pain Management - Fentanyl indications

Answer 14

Pain

Question 15

Pediatric Pain Management - Fentanyl intranasal dose

Answer 15

2 mcg/kg single max of 100 mcg, divided equally between nares
Repeat 0.5-1 mcg/kg q 15 min x 1

Question 16

Pediatric Pain Management - Fentanyl IM/IV loading dose

Answer 16

1 mcg/kg SIVP/IM/IO single max dose of 50 mcg q 5 min prn to a total max of 150 mcg

Question 17

Pediatric Pain Management - Fentanyl IV/IM maintenance dose < 50kg

Answer 17

fentaNYL 1 mcg/kg per hour SIVP/IM/IO to a max of 1 dose per hour
Maintenance dose starts after loading dose administered

Question 18

Pediatric Pain Management - Fentanyl EMS contraindications

Answer 18

Hypersensitivity
MAOI therapy within last 14 days
Systolic BP less than 70 + (2 x age) mmHg

Question 19

Pediatric Pain Management - Fentanyl precautions

Answer 19

Intranasal fentaNYL is not to be used in children under the age of 1 year
Use cautiously if evidence of ETOH or drug intoxication
May cause respiratory depression

Question 20

Pediatric Pain Management - Ketamine indications

Answer 20

Mandatory OLMC – pain in hypotensive patients and pain refractory to morphine or fentaNYL

Question 21

Pediatric Pain Management - Ketamine dose

Answer 21

Mandatory OLMC - 0.2 mg/kg SIVP/IO

Question 22

Pediatric Pain Management - Ketamine EMS contraindications

Answer 22

Hypersensitivity

Conditions where a significant elevation of blood pressure is hazardous

Question 23

Pediatric Pain Management - Ketamine precautions

Answer 23

Can increase HR and BP
Can induce hypersalivation and tracheobronchial secretions
Have suction available and ready

Question 24

Pediatric Pain Management - Pediatric Pain Management - Fentanyl IV/IM maintenance dose > 50kg

Answer 24

1mcg/kg per hour SIVP/IM/IO single max of 50 mcg q 10 min prn
Maintenance dose starts after loading dose administered