Children Pain Management in ED

Last Updated on by FRCEM Intermediate

Children Pain Management in ED

Non-pharmacological adjuncts:

  • Limb immobilisation and elevation
  • Cooling and dressings for burns
  • Definitive treatment e.g. reduction of pulled elbow

Pharmacological management of pain:

Mild pain

  • Oral/rectal paracetamol 20 mg/kg loading dose, then 15 mg/kg 4 – 6 hourly OR
  • Oral ibuprofen 10 mg/kg 6 – 8 hourly

Moderate pain

  • As for mild pain PLUS
  • Oral/rectal diclofenac 1 mg/kg 8 hourly (unless already had ibuprofen) AND/OR
  • Oral codeine phosphate 1 mg/kg 4 – 6 hourly (over 12 years old only) OR
  • Oral morphine 0.2 – 0.5 mg/kg stat

Severe pain

  • Consider entonox as holding measure THEN
  • Intranasal diamorphine 0.2 ml (= 0.1 mg/kg) FOLLOWED BY/OR
  • IV morphine 0.1 – 0.2 mg/kg
  • Supplemented by oral analgesics

 

Psychological strategies:

  • Parent and family member involvement
  • Child-friendly environment
  • Explanation with reassurance
  • Distraction with toys, blowing bubbles, reading or storytelling
  • Play specialist

Topical anesthesia

  • Ethyl chloride spray
  • EMLA cream
  • Ametop gel
  • LAT gel

Procedural sedation

  • Ketamine (IV/IM)
  • Midazolam (Oral/intranasal)

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