Obvious Pediatric Pain (6 months-18 years)
Last Updated: 1/19/2016 8:17:23 PM
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 Obvious Pediatric Pain (6 months-18 years) - http://www.curbsideup.com/link/33
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  Inclusion Criteria
Inclusion Criteria ( Any one criteria present )
  • Obvious significant pain (source not important)
Exclusion Criteria
  • Hx of high risk airway disease, surgery or tracheostomy
  • Respiratory distress or oxygen requirement
  • Head/mid-face trauma, LOC or mental status changes
  • Toxic appearance
  General
  Monitoring
Weight
ONCE
Vitals signs
Per protocol and repeat 15 min before and after each narcotic medication is given.
Wong-Baker FACES Pain Rating Scale
Please complete pain assessment.
  Does this patient need to be NPO?
Yes
Diet NPO
Continuous
No
PO Challenge
Diet Regular
Nursing communication
Make patient NPO for respiratory distress, mental status changes or expectation of pending surgical or other procedure requiring sedation
  Medications
  Pain Control
lidocaine (ELA-MAX, LMX) 4% cream
Topical, ONCE, Apply small amount to skin PRN, painful procedure, Note: takes 30 min to reach peak effect,,
lidocaine-tetracaine (SYNERA) patch 1 Patch
Transdermal, ONCE, for 30 min, PRN painful procedure, Note: takes 20 min to reach peak effect
Sucrose 24% (TOOTSWEET) soln 5 drops
5 drops in mouth/throat if pain score is mild (1-2), Used for procedures, PRN
Nitrous oxide (SEDARA) inhalation analgesic
Inhalation, PRN, Procedure inhalation analgesia
  Mild Pain (1-4) and appropriate for PO
  Assessment
Nursing Communication
Please reassess of pain level every 30 min
  Does patient have any contraindications to acetaminophen?
      Allergy or hypersensitivity, hepatic impairment, severe hypovolemia, PKU or other liver disease, chronic malnutrition
No
Acetaminophen (TYLENOL) oral solution 15 mg/kg (Dosing Weight)
15 mg/kg, Oral, EVERY 4 HOURS PRN, Pain mild, Temp > 38.5 C, (max 650mg)
Acetaminophen (TYLENOL) tablet 650 mg
650 mg, Oral, Every 4 HOURS PRN, Pain mild, Temp > 38.5 C
Acetaminophen (TYLENOL) suppository
20 mg/kg, Rectal, Every 4 HOURS PRN, Pain mild, Temp > 38.5 C
  Does patient have any contraindications to ibuprofen?
      Allergy or hypersensitivity, G6PD, renal impairment, severe hypovolemia, bleeding or coagulation disorder, gastritis or PUD, long bone fracture
No
Ibuprofen (MOTRIN) oral solution 10 mg/kg (Dosing Weight)
10 mg/kg, Oral, EVERY 6 HOURS, PRN, Pain mild, Temp > 38.5 C
Ibuprofen (MOTRIN) tablet 200 mg
600 mg, Oral, EVERY 6 HOURS, PRN, Pain mild, Temp > 38.5 C
  Moderate to Severe Pain (5-10) and/or NPO
  Assessment
Nursing Communication
Please reassess of pain level every 10 min
  Contraindications to Intranasal Fentanyl or IV pain medication preferable?
      Allergy or hypersensitivity, recent nasal injury or surgery, active or recent epistaxis, occluded nasal passages, altered mental status
Yes
Morphine injection 2 mg
0.05 mg/kg, IV, Once
No
Fentanyl 50 mcg/ml intranasal solution - Less than 30 kg
2 mcg/kg, Intranasal, Once - Less than 30 kg
Sufentanil 50 mcg/ml intranasal solution (max 100mcg) - Greater than 30 kg
0.7 mcg/kg, Intranasal, Once, (max 100mcg) - Greater than 30 kg
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