Pediatric Intravenous Medication Administration in the Emergency Department, Part 3: Rip Van Winkle’s Approach to Pediatric Procedural Sedation

• Published in: Journal of emergency nursing 2016-11, Vol.42 (6), p.535-540
• Main Authors: Normandin, Patricia A., Benotti, Stacey A.
• Format: Article
• Language: English
• Subjects: Administration, Intravenous - methods; Airway management; Amnesia; Analgesia; Anesthesia; Anesthesia, Intravenous - methods; Anesthetics, Intravenous - administration & dosage; Angina; Anxiety; Apnoea; Barbiturates; Bipolar disorder; Catheters; Chest; Child; Children & youth; Cognitive impairment; Coma; Critical incidents; Dissociative amnesia; Drug administration; Drugs; Elimination; Emergency Nursing - methods; Emergency Service, Hospital; Emergency services; Eye injuries; Families & family life; Family medical history; Glaucoma; Heart; Heart diseases; Heart failure; Hostility; Humans; Hypertension; Hypnosis; Hypotension; Infections; Management; Mental depression; Narcotics; Nitrous oxide; Nurses; Nursing; Pain; Patients; Pediatric Nursing - methods; Pediatrics; Physicians; Practice Guidelines as Topic; United States; Ventilation; Vomiting
• ISSN: 0099-1767; 1527-2966
• DOI: 10.1016/j.jen.2016.07.002

The Facial, Legs, Activity, Cry, Consolability (FLACC)/Revised FLACC scale has been found to be an appropriate pain assessment tool for preverbal children younger than 3 years of age, as well as children who are critically ill or have cognitive impairment.\n5 5 to 15 Effect: provides sedation (no analgesia)Administration: very irritating; avoid administration into small vessels; may premedicate with lidocaineAdverse effects: may cause adrenal suppressionAntidote: noneAdditional information: minimal effects on hemodynamics Pentobarbitald (barbiturate) IV, PO, PR IV = 1 to 5 IV = 15 to 90 Effect: sedation and hypnosis (no analgesia)Administration: administer slowlyeAdverse effects: respiratory depression (especially in combination with other sedatives/opioids)Contraindications: patients with porphyriaAntidote: noneAdditional information: IV formulation may be given PO Chloral hydrate (sedative-hypnotic) PO, PR PO = 10 to 15 PO = 60 to 240 Effect: sedation and hypnosis (no analgesia)Administration: do not crush capsule; contains liquid with unpleasant taste; can give syrup formulation orally and rectallyAdverse effects: gastrointestinal irritation and vomiting when given orally; prolonged sedation, coma, paradoxical agitation, respiratory depressionContraindications (relative): patients with cardiac, liver, or renal impairmentAntidote: none Fentanyld (opioid) IV, IN IV = 1 to 3 IV = 30 to 60 Effect: analgesiaAdministration: IV formulation may be given IN by giving half the dose into each nostril using an atomizer or dripping slowly into the nostril with a syringe if nasal spray is not availableAdverse effects: respiratory depression, hypotension, chest wall rigidlyAntidote: naloxone Morphine (opioid) IV, PO, IM, SC, SL IV = 20 IV = 240 Effect: analgesiaAdministration: inspect vial closely for particulate matter and discoloration prior to administration; utilize preservative-free formulation when possibleAdverse effects: respiratory depression/apnea, hypotensionAntidote: naloxone Ketamined(general anesthetic) IV, IM, IN, PO IV = 1 to 2 IV = 15 to 30 Effect: sedation, dissociative amnesia, analgesiaAdministration: IV formulation may be given IM, IN, and POAdverse effects: vomiting (can premedicate with ondansetron), emergence reaction, laryngospasm, and apnea (most common with IM administration; can usually be managed with positive pressure bag-mask ventilation)Contraindications: Younger than 3 months old and patients with known/suspected psychosisAntidote: non