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EMR
EMT
AEMT
Paramedic
Extended
Pediatric Pain Control
Pediatric Pain Control
Universal Pediatric Assessment
Determine cause of pain
Use Wong-Baker Faces pain scale
Pediatric IV/IO
If not given in the
last 6 hours:
If older than 6 months:
If clearly justified:
Tylenol
15mg/kg PO
Maximum 500mg
Zofran
1 month to 12 years old
<30kg/66lbs:
0.1mg/kg IV/IO x 1
or ½ an ODT
>30kg/66lbs:
4mg IV/IO/ODT
Maximum 4mg
Ketamine
0.2mg/kg IV/IO/IM
or
Ketamine
0.3 mg/kg Nebulized
or
Ketamine
1 mg/kg via MAD
Repeat IV/IO dose in 10 minutes if
source of obvious pain
Clinical Considerations
Make parents aware:
Ketamine is a
hallucinogen
Ketamine causes
nystagmus
Second dose must be
clearly justified
Clinical Considerations
Ketamine IV/IO must be
diluted to 5mg/mL
Do not dilute ketamine
for MAD or IM routes
Ketamine may be less
effective via MAD or IM
Alternative routes are
offered to minimize
patient anxiety and
facilitate administration
Biovailability of
alternative routes guides
the dose ranges
Keep patient calm
Clinical Considerations
Ketamine Contraindications:
Patients < 2 months old
Schizophrenia
Allergy to ketamine
Visceral Pain
Non-obvious Sources
Painful Procedures
Cardioversion
TCP
Orthopedic Pain
Obvious Sources of Pain
Consider
Ketamine
0.4mg/kg
IV/IO/IM
Maximum 40mg
.
Be
prepared
for
side effects
Hallucinations
Nausea
Nystagmus
< 16 years old
Clinical Considerations
Never delay a lifesaving
therapy such as cardioversion
or TCP to provide sedation.