Pain management in peds

Question 1

What are pain cues in newborn?

Answer 1

High pitched shrill cry
Thrashing and tremors
Increase in BP, HR, RR
Decrease in O2 Sat
Facial expression (Eyes tightly closed, brows lowered and drawn together, wrinkled forehead)

Question 2

What does FLACC stand for? Used for?

Answer 2

F=Face
L=Legs
A=Activity
C=Cry
C=Consolability
—-Pain scale for newborns or nonverbal kids—
—Sort of like APGAR (except high score is bad and low score is good). Given 0, 1, 2 points. The higher the score the worse the markers are for pain.—

Question 3

What are some non-pharm pain interventions for NB?

Answer 3

Quiet <40 decibels
Dim lights
Holding, touching, vibrations, rocking
Kangaroo care
Sucking on pacifier or nursing
Sweet ease
Swaddling

Question 4

Why are IM injections for pain meds used as last resort in kids?

Answer 4

Fear of pain and upset
Muscle not absorbent enough to provide consistent flow of med
Short duration

Question 5

What are some topical anesthetics used in peds?

Answer 5

Lidocaine-prilocaine 5% (EMLA)
Amethocaine 4% (Ametop)
Vapocoolant spray (works fast)
J-Tip (device to deliver lidocaine into skin)

Question 6

Drug of choice for fever in kids.

Answer 6

Tylenol

Question 7

Caution for Tylenol administration.

Answer 7

Must monitor total amount received over 24 hours closely because
Tylenol is mixed in with opioid meds to increase effectiveness.
Can cause hepatic damage in overdose.

Question 8

What is max dosage of Tylenol in peds?

Answer 8

No more than 6 doses in 24 hours.
—90 mg/kg/daily–

Question 9

What is dosage of Tylenol?

Answer 9

10-15 mg/kg/dose q 4-6 hours
(q 6-8 hours in neonates)

Question 10

What are absolute contraindications for Tylenol?

Answer 10

thrombocytopenia
—Platelets too low–
Anemia
Hepatic disease

Question 11

How old must a child be for NSAID use?

Answer 11

> 6 months old

Question 12

What is dose of ibuprofen?

Answer 12

8-10 mg/kg/dose q 6-8 hours

Question 13

What is an IV administered NSAID?

Answer 13

Toradol (ketorolac)
Dose is 0.5 mg/kg
Not given to children less than 6 months old.

Question 14

What are the most common side effects of opioid administration?

Answer 14

Sedation-resolves after 1-3 days
Pruritus-resolves after 1-3 days
N/V-resolves after 1-3 days
Urinary retention-resolves after 1-3 days
Cough suppression
Constipation
Respiratory depression

Question 15

Which opioid is unsafe for children?

Answer 15

Codeine
–Because some kids metabolize it too fast and OD–

Question 16

Which is preferred opioid for children?

Answer 16

Morphine

Question 17

Which opioid of 5 times more potent than morphine?

Answer 17

Dilaudid

Question 18

Which opioid is 100 times more potent than morphine?

Answer 18

Fentanyl

Question 19

Which opioid is metabolized the most slowly? What is its most common side effect?

Answer 19

Methadone and Nausea
Prolonged duration of action
Comes in liquid form too

Question 20

Which opioid is given only for post-op shivering and rigors in kids?

Answer 20

Demerol (meperidine)

Question 21

Do opioids have dose limits?

Answer 21

No-The max dose is the dose that causes unacceptable side effects.
Unique to every person.

Question 22

What is preferred route for pain meds in children?

Answer 22

Oral or IV
–As soon as possible, we change from IV admin to oral–

Question 23

Hydrocodone is usually mixed with…

Answer 23

Acetaminophen or
Ibuprofen

Question 24

Dosage for morphine.

Answer 24

PO=0.2—0.5 mg/kg/dose q 4-6 hours

IV= 0.05—0.1 mg/kg/dose q 2-4 hours

Question 25

What is Dilaudid’s generic name?

Answer 25

Hydromorphone

Question 26

What is fentanyl patch called?

Answer 26

Duragesic
–used for chronic pain–