Pain Management
Name a validated pain scale for children over 4 years old who can self report their pain
Faces Pain Scale-Revised, Color analog scale, 11-point numeric rating scale
How long should you wait to suture after applying LET?
20-30 minutes
What has a shorter onset of action, EMLA (lidocaine and prilocaine) or LMX (lidocaine)?
LMX is 20 minutes, and EMLA is 45-60 minutes
Show how to block a finger for a nail bed laceration
Correct demonstration on dorsal and palmar sides
True or False: lacerations from a wild rabid animal should be cleansed extensively and sutured
False
Name a validated behavioral pain scale suitable for under 4 years old who can't self report their pain
Faces, Legs, Activity, Cry, Consolability (FLACC) Scale
What is the max volume of 1% lidocaine that can be administered to a 10 kg patient?
4.5 ml (will accept 5ml answer)
What is the max volume of 1% lidocaine with epinephrine that can be administered to a 10 kg patient?
7 ml
Name 2 typical anesthetics for a regional nerve block
lidocaine, bupivacaine, and ropivacaine
How would you remove tissue adhesive (Dermabond) if accidentally drips onto the patient or into the wound, and has already polymerized?
Petroleum-based products, like petroleum jelly or bacitracin, applied for 30 minutes
Why should analgesia not be withheld in children with acute abdominal pain
Evidence shows it does not mask clinical symptoms and improves pain without impacting diagnostic accuracy
Which opioid is not recommended for children under 12 years due to variable metabolism?
Tramadol
What is a known complication of fentanyl if rapid IV administration and higher dosing?
Chest-wall rigidity
How would you block the facial nerve:
- Supraorbital (V1)
- Infraorbital (V2)
- Mental (V3)
100 points for each block
What prophylactic antibiotic therapy is recommended for the prevention of wound infection from dog bites when a patient has a severe allergy to Amoxicillin?
Extended-spectrum cephalosporin (such as cefdinir) or TMP-SMX or Doxycycline, PLUS clindamycin
What nonpharmacologic methods are effective for managing procedural pain in infants?
Non-nutritive sucking, swaddling, breastfeeding, and distraction techniques
How would you buffer 1% lidocaine to decrease the burning when administered?
9 mL of 1% lidocaine and combining it with 1 mL of 8.4% sodium bicarbonate (9:1 ratio or 1:10 dilution)
How do you treat severe pruritus from morphine?
Antihistamines, low dose Naloxone, Zofran
Which nerve block would provide pain relief for a femur fracture?
Fascia Iliaca Nerve Block
A child presents from daycare with a bite mark. You measure the intercanine distance of 3cm. Besides cleaning the wound and starting prophylactic antibiotics, what else do you want to do?
SW/NAT - Normal adults have an intercanine distance of 2.5 to 4 cm, so any bite that falls within that intercanine distance is suspicious for abuse
6 month old diagnosed with Influenza presents with severe emesis and irritable, now somnolent. He has enlargement of the liver without jaundice. Labs show hypoglycemia and transaminitis. What did he receive at home?
Aspirin (Reye Syndrome)
What Tylenol and Motrin dosing in mL do you tell the parents of a 20kg child?
Tylenol 9ml (9.4ml) and Motrin 10ml.
Tylenol come in 160mg in each 5ml.
Motrin comes in 100mg in each 5ml.
What is the potential complication for neonates receiving topical EMLA?
Methemoglobinemia from the metabolites of prilocaine secondary to low levels of methemoglobin reductase
While performing a nerve block, the patient becomes confused, hypotensive, and bradycardic. What is the treatment.
ABC first. Benzos for seizures. Treatment is lipid emulsion therapy.
9 year old presents with a dirty laceration to his foot. His last immunizations were the 12 month vaccines. Should he receive anything for tetanus prophylaxis today?
Under 3 doses & dirty: TIG + tetanus vaccine
Over 3 doses & dirty: tetanus booster if >5 years since last update
Over 3 doses & clean: tetanus booster if >10 years since last update
Tetanus doses: 2mo, 4mo, 6mo, 18mo, 4-6yo, 11-12yo
DTap if <7yrs; Tdap if ≥7 yrs