4-8 PEDIATRIC PAIN MANAGEMENT

Note that this protocol assumes that the patient’s primary condition is being assessed and treated according to the appropriate protocol and is intended for use only as an adjunct to other care.

Inclusion Criteria without prior Medical Control Authorization:

1. Age greater than 6 year
2. Isolated hip or extremity injury
3. Burns
4. No known allergies to medications being administered
5. No known exclusion criteria present

Inclusion Criteria that require Medical Control contact prior to medication administration:

1. Abdominal Pain
2. Age > 1 year, but < 6 years

Exclusion Criteria:

1. Known allergy to medication
2. Respiratory distress with potential for patient fatigue
3. Evidence of poor perfusion
4. Altered Mental Status
5. Multi System Trauma

EMR - Emergency Medical Responder

1. Assess the patient for any areas of significant discomfort
2. Consider use of non-pharmacologic adjuncts to pain control such as positioning, ice, elevation and reassurance.
3. Consider need for ALS intercept if patient has significant pain  

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assess the patient’s pain using an age appropriate device, such as a numerical pain scale or visual analog scale if available.
2. Initiate transport and discuss possibility of ALS intercept for pharmacologic pain control with the patient and family. Contact MEDICAL CONTROL and if appropriate,  based on transport time, condition and patient desires, request ALS intercept.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Consider need for vascular access and administer NS at a TKO rate if indicated. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 do not attempt further IV placement
2. Initiate transport and Contact MEDICAL CONTROL to discuss if ALS intercept is appropriate based on transport time and patient condition. If the sole reason for initiation of an IV is pain control, and an ALS intercept is not practical, attempts at IV placement should be deferred to the hospital.

Intermediate - Perform/Confirm All Above Interventions

1. Assess patient condition, including vital signs, mental status, pain level and respiratory status. If narcotics are to be utilized, place the patient on pulse oximetry.
2. If patient indicates a pain scale of greater than 5 and has no signs of poor perfusion or respiratory depression, administer fentanyl (Sublimaze) 1 mcg/kg INTRANASAL or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IVIO. Reassess patient vital signs and pain scale after 5 minutes.
3. Initiate transport and Contact MEDICAL CONTROL for further orders.
4. Reassess vital signs, mental status, pain level and respiratory effort and if continued pain over 5, Contact MEDICAL CONTROL for any further dosages.

Paramedic - Perform/Confirm All Above Interventions