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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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