162. Peds procedural sedation and analgesia

Question 1

6 item equipment list for sedation

Answer 1

SOAP-ME
o	Suction
o	Oxygen supply
o	Airway equipment
o	Pharmacy – meds and antagonists
o	Monitors
o	Equipment or drugs for a particular case

Question 2

5 ASA classes

Answer 2

1. Normal healthy
2. Mild system disease with no limitations
3. Severe systemic disease with functional limitations
4. Severe systemic disease that is constant threat to life
5. moribund

Question 3

6 sedative options and SEs for each

Answer 3

1. etomidate
   - pain
   - adrenal insuff
2. ketamine
   - laryngospasm
   - vomiting
   - emergence
3. midaz
   - paradoxical agitation
   - vomiting
   - resp depression
   - apnea
4. Phenobarb
   - CV and resp depression
   - paradoxical agitation
5. Prop
   - CV and resp depression
6. NO
   - can’t use if trapped air in bowel

Question 4

4 steps to manage laryngospasm

Answer 4

o Position
o BVM
o Give 10% dose of sux
o RSI PRN

Question 5

mgmt of emergence reaction

Answer 5

Midaz 0.03mg/kg dose

Question 6

when to use anti-cholinergics

Answer 6

o	Ketamine increase secretions
o	Anti-chol not necc 
o	If needed
	Glycopyrrolate
•	More potent anti-sialogogue

Question 7

5 non-pharma pain mgmt methods

Answer 7

• Distraction
• Hyponosis
• Child life specialist
• Parental presence
• Sucrose water

Question 8

4 topical analgesia options and contraindications

Answer 8

1. EMLA - lido/prilo
   - <3 months
   - any methomoglbinemia RFs
2. LIMX - lido
   - same as EMLA
3. LET - lido/epi/tetra
   - any area of compromised blood supply
4. vapo-coolant
   - compromised blood supply
   - insenstive skin

Question 9

2 classes of local anesthetics

Answer 9

o Amide
- End in caine
o Esters

Question 10

what make local more potent

Answer 10

lipid solubility

Question 11

8 ways to make local less painful

Answer 11

1. use topical agent first
2. small needle
3. warm solution
4. inject slowly
5. inject subcut
6. minimize # of punctures
7. inject into wound
8. buffer with bicarb

Question 12

Sx of local tox

Answer 12

CNS and CVS systems
o Tingling lips, metallic taste, tinnitus
o drowsy, seizures, status epi, coma

Question 13

4 complications of local blocks

Answer 13

o Needle break
o Damage to adjacent structures
o Neurotoxicity
o Vascular complications

Question 14

4 non-opioid analgesics

Answer 14

1. tylenol
2. aspirin
3. ibuprofen
4. toradol

Question 15

5 PO opioids

Answer 15

1. hydrocodone
2. oxycodone
3. hydromorphone
4. morphine
5. tramadol

Question 16

3 IV opioids

Answer 16

1. fentanyl
2. morphine
3. hydromorphone