ORTHOPAEDICS - PAEDIATRICS
ANALGESIA IN PAEDIATRIC FRACTURES
You will be asked this
PromptWeight estimation vs age
ResponseAPLS formula
Weight (kg) = (Age +4)x2
Weight (kg) = (Age +4)x2
PromptDescribe your approach to analgesia in a significant paediatric fracture
ResponsePharmacological
Oral analgesia - Paracetamol 15 mg/kg, Ibuprofen 10 mg/kg
Opiate analgesia - IN fentanyl 1.5 mics/kg, IV morphine 0.1 mg/kg (Watch for sedation, resp depression, vomiting, itch, epistaxis)
Inhaled nitrous oxide
Non pharmacological
Immobilisation in - Splint/backslab/POP
Reassurance/distraction by parents
Nerve block (eg: FIB)
Oral analgesia - Paracetamol 15 mg/kg, Ibuprofen 10 mg/kg
Opiate analgesia - IN fentanyl 1.5 mics/kg, IV morphine 0.1 mg/kg (Watch for sedation, resp depression, vomiting, itch, epistaxis)
Inhaled nitrous oxide
Non pharmacological
Immobilisation in - Splint/backslab/POP
Reassurance/distraction by parents
Nerve block (eg: FIB)
PromptFemoral nerve block in 6 yo child
ResponseConsent - verbal/written
EMLA to site (if time allows this)
Calculate local anaethetic - (Lignocaine 4 mg/kg, Bupivicaine 2mg/kg)
Landmarks or ultrasound guided technique - nerve lateral to artery
Inject and aspirate with nerve stimulator needle
Document in notes
EMLA to site (if time allows this)
Calculate local anaethetic - (Lignocaine 4 mg/kg, Bupivicaine 2mg/kg)
Landmarks or ultrasound guided technique - nerve lateral to artery
Inject and aspirate with nerve stimulator needle
Document in notes
PromptREDUCTION IN ED
Response
PromptFactors to consider before reducing fracture in ED
ResponsePatient factures
- Severiity of injury - complications evident
- Need for ORIF regardless of ED reduction
- Patient preference
- Other injuries (But be wary as if quesion states no other injury won’t get paid)
- Staffing
- Skillset
- Environment - not controlled, unpredictable workloads
- Time of day