UCSD Pediatrics Burn Pain Management Site |
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Initial Management |
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| During the acute phase of the burn children often do not complain of much pain at rest. This is probably due to an outpouring of stress hormones and endorphins. When the patients then are moved or the wounds are being debrided, intense pain may be experienced. It is at this time analgesics should be administered. It is important to realize that due to shock and hypovolemia patients may have an increased likelyhood of hypotension and and respiratory depression. Also many infants or small children will arrive to the unit with no IV in place, but are still extremely uncomfortable. Some patients will arrive many hours after the burn and arrive in intense pain on presentation. | |||||||
| Minutes to hours after injury:
1. For initial analgesia If IV access has been established, Fentanyl 1-2 mcg/kg Morphine 0.1-0.2 mg/kg If IV access is not yet available and IV difficult to place Fentanyl 1-3 mcg/kg IM Morphine 0.1-0.2 mg/kg IM Ketamine 3-10mg/kg PO or IM Oxycodone liquid 0.1mg/kg PO 2.For initial wound debridment: If IV access has been established, Fentanyl 1-2 mcg/kg Morphine 0.1-0.2 mg/kg Consider adding sedative (watch for severe respiratory depression) Lorezepam (ativan) 0.05-0.2 mg/kg Midazolam (versed) 0.05-0.2 mg/kg 3. For Severe burns or placement of trancyte where immobility is needed: If patient is not intubated, Consider consulting Anesthesia or Pediatric Critical Care service for Deep sedation or General anesthesia Consider the above regimines and re-dose as necessary If patient is intubated, Combination of opioids and Benzodiazepines Fentanyl 5-10mcg/kg or Morphine 0.1-0.3 mg/kg or Hydromphone 0.02-.06 mg/kg as hemodynamics allows PLUS Midazolam or Lorazepam 0.05-0.2mg/kg |
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