Analgesics and sedatives (peds): Difference between revisions
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==Evaluation== | ==Evaluation== | ||
There are a number of well established frameworks for evaluating pain that are helpful in the pediatric ED. Which framework works best is dependent on the age of the patient and provider preference. | There are a number of well established frameworks for evaluating pain that are helpful in the pediatric ED. Which framework works best is dependent on the age of the patient and provider preference<ref>“Pediatric Pain.” n.d. Accessed October 14, 2022. http://www.emra.org/books/pain-management/pediatric-pain/.</ref>. | ||
===Neonates=== | ===Neonates=== | ||
CRIES Scale (used to establish baseline and assess discomfort over time): | CRIES Scale (used to establish baseline and assess discomfort over time): | ||
{| class="wikitable" | |||
|+ CRIES | |||
|- | |||
! !! 0 !! 1!! 2 | |||
|- | |||
| Crying || None || High-pitched || Inconsolable | |||
|- | |||
| Requires O<sub>2</sub> || None || <30% FiO<sub>2</sub> needed || >30% FiO<sub>2</sub> needed | |||
|- | |||
| Increased Vital Signs || Normal HR and BP || Increased HR and BP <20% || Increased HR and BP >20% | |||
|- | |||
| Expression || Normal || Grimace || Grimace and Grunt | |||
|- | |||
| Sleeplessness || None || Wakes frequently || Awake constantly | |||
|} | |||
===Infants=== | ===Infants=== | ||
* <1yo: NIPS Scale (score of >5 generally should be treated pharmacologically)<br> | * <1yo: NIPS Scale (score of >5 generally should be treated pharmacologically)<br> | ||
* >1yo: FLACC Scale | * >1yo: FLACC Scale | ||
===Verbal Children >3=== | |||
Wong-Baker | |||
==Pediatric doses for Common Analgesics== | ==Pediatric doses for Common Analgesics== | ||
Revision as of 16:37, 14 October 2022
Introduction
Analgesia and sedation considerations, particularly in the nonverbal population, requires a more careful approach than typically needed in the adult population. Children may require sedation for procedures that are done with topical anesthetic in the adult population and evaluation of pain in infants and young children can be challenging. This page contains considerations for evaluation, options for anesthesia and sedation, and dosages for common analgesics and sedatives.
Evaluation
There are a number of well established frameworks for evaluating pain that are helpful in the pediatric ED. Which framework works best is dependent on the age of the patient and provider preference[1].
Neonates
CRIES Scale (used to establish baseline and assess discomfort over time):
| 0 | 1 | 2 | |
|---|---|---|---|
| Crying | None | High-pitched | Inconsolable |
| Requires O2 | None | <30% FiO2 needed | >30% FiO2 needed |
| Increased Vital Signs | Normal HR and BP | Increased HR and BP <20% | Increased HR and BP >20% |
| Expression | Normal | Grimace | Grimace and Grunt |
| Sleeplessness | None | Wakes frequently | Awake constantly |
Infants
- <1yo: NIPS Scale (score of >5 generally should be treated pharmacologically)
- >1yo: FLACC Scale
Verbal Children >3
Wong-Baker
Pediatric doses for Common Analgesics
Non-Opioid
- PO/PR: 10-15mg/kg/dose q4-6hrs
- Children’s Tylenol is 160mg/5ml
- Max: 75mg/kg/day or 4000mg/day
- PO: 4-10mg/kg/dose q6-8hrs
- Children’s Motrin is 100mg/5ml
- Max: 40mg/kg/day
- IM/IV: 0.5mg/kg/dose q6hrs
- PO: 1-2mg/kg/dose q4-6hrs
Opioid
Naloxone (opioid overdose reversal)
- IV/IM: 0.001-0.02mg/kg/dose
- IM/IV: 0.05-0.2mg/kg/dose q2-4hrs
- IV: 0.015mg/kg/dose q4-6hrs
- PO: 0.03-0.08mg/kg/dose q3-4hrs
- IV: 1-2 mcg/kg/dose q1-2hrs
- IN: 1-2 mcg/kg/dose via atomizer
- PO: 0.05-0.15mg/kg/dose q4-6hrs
- PO: 0.5=1mg/kg/dose q4-6hrs
- IV/PO: 0.05-0.1mg/kg/dose q6hrs
Combination Medication
Acetaminophen with Codeine
- PO: 0.5-1mg/kg/dose of codeine q4-6hrs
Acetaminophen with Hydrocodone
- PO: 0.15mg/kg/dose of hydrocodone q4-6hrs
Acetaminophen with Oxycodone
- PO: 0.05-0.15mg/kg/dose of oxycodone 14-6hrs
Pediatric doses for Common Sedatives
- IM: 0.05-0.15mg/kg; max 10mg
- IV:
- 6mo-5yr: 0.05-0.1mg/kg initially with up to 0.6mg/kg needed; max 6mg
- 6yr-12yr: 0.025-0.05mg/kg initially with up to 0.4mg/kg needed; max 10mg
- 12yr-16yr:1-2mg initially with up to 2.4-5mg needed; max 10mg
- PO: 0.25-0.5mg/kg; max 20mg
- IV/PO: 0.05-0.1mg/kg q4-8hrs
- IV: 0.5-2mg/kg
- IM: 3-7mg/kg
- PO: 25-50mg/kg
- IV: 1-2mg/kg over 30 seconds
- IV: 0.3mg/kg
See Also
References
- ↑ “Pediatric Pain.” n.d. Accessed October 14, 2022. http://www.emra.org/books/pain-management/pediatric-pain/.