Pediatric Palliative Care Flashcards
Use of Faces pain scale revised (FPS-R)
Age: 4-12 yo self reported by child
Quick to use
Pieces of hurt tool/poker chip tool
Age: 3-12 yo (less reliable for 3-4yo)
Self reported by kid
concrete ordinal rating scale
Visual analogue scale
Age: above 8 yo
self reported by child
Sensitive to change, correlates with parents ratings of kids pain
Con: more recall bias, high degree of abstraction
The oucher photographic scale
Age: 3-12 yo
color photo of childs face with different pain expressions
Numerical rating scale (NRS)
Age: older than 8yo
scale of 1-10
Opioid differences in neonates (<3mo)
Immature liver fxn–> slower metabolism
Decreased clearance by kidneys
High ratio of body water:fat –> increases volume of distribution–> increase duration of action
Lower levels of albumin and glycoprotein–> increase ratio of unbound (active):bound (inactive) drug–> increase effect of each dose
Reduced ventilatory response to low O2 and high CO2–> inadequate gas exchange
CRIES
Age: Pain scale for neonates
Crying (no, high pitched, inconsolable)
Requires O2 for sat >95%
Increased vital signs
Expression (grimace)
Sleepless
FLACC pain assessment
When do kids develop pain specific language
17-23mo
What age do kids add descriptive language to pain specific language
30mo
What age can kids explain the intensity of pain
4-6yo
What age can kids localize pain and discuss causation?
7-11yo
Duration and peak of hydromorphone
Duration: 4h
Peak:
- PO 45-60min
- SC 15-30 min
- IV 5-15min
Duration and peak of fentanyl
Duration 30-60min
Peak:
- SC 15-30min
- IV 5-15min
Rate to titrate opioids
Mild-mod pain -> 25-50%
Mod to severe-> 50-100%
How much to uptitrate breakthrough pain meds
5-15% of total daily dose
How to titrate IV or SC infusion
increase basal 25-100%
give loading dose = 2-3x basal before increase
titrate every 20h
How to taper opioids?
decrease dose by 10-20% every 1-2d
once dose is <0.6mg/kg (if <50kg) or 30mg/d (if >50kg)
tx malignant pruritis
cimetidine
Paroxetine
steroids
Tx cholestasis pruritis
Cholestyramine
opioid antagonist
tx uremia pruritis
UVB therapy
gabapentin
tx opioid pruritis
naloxone gtt
tx hard to treat pruritis
Doxepin
Assessment tool for dyspnea in kids
Dalhousie Dyspnea Scale
- throat closing
- chest tightness
- effort
for 8-18 yo
Tx delirium in kids
Haldol or resperidone
tx acute dystonia– biperiden
tx agitated delirium in kids
chlorpromazine
Tx insomnia in kids
- Melatonin
- trazodone
hypnosis, CBT
Tx fatigue in PPD
non-pharm (energy conservation)
Methylphenidate (not for HTN, seizures, anxiety or agitation)
tx of bleeding in kids
Midazolam
Prevention of more bleeding: Tranexamic acid or aminocaproic acid
Tx anorexia and cachexia in kids
megesterol and cyproheptadine
PEG
steroids –not great b/c SE
Tx obstruction in kids
Anticholinergic (decrease secretion and bowel contraction)
Antiemetics
Octreotide
endoscopic stenting
+/- NG
Steroids if etiology is edema from tumor
tx of dystonia
trihexyphenidyl
