Paediatric Acute care Guidelines PMH Emergency Department

Background

  • All children with burns will require analgesia
  • Those requiring admission to hospital will generally require opiates
  • It is essential that the child has been given appropriate long acting medications prior to transfer to the burns unit

Management 

Medications – in the Emergency Department

Pain Severity Drug Route   Dose   Comments
Severe Fentanyl   IN 1.5 micrograms / kg
Titrate to effect 5 minutely
Fentanyl is the first choice but if not available or IV access attained for other reasons, then use IV Morphine
Morphine   IV 0.05 – 0.1mg / kg
Can repeat 5 minutely
until effective
If pain is severe, IV Morphine can be used even if patient has had IN Fentanyl
Oral medication
as below
  PO   Give soon after first dose of Fentanyl or Morphine
Mild
to
Moderate
Paracetamol   PO

15mg/kg

 
Ibuprofen   PO 10mg / kg
(Max dose=400mg)
Not to be used if < 3 mths old

Oxycodone PO 0.05-0.1mg/kg  

Medications – Burns Ward

  Drug  Route   Dose  Comments 
After Hours:
When the child is admitted to the Burns Ward between 2200-0800 hrs please chart the following on ward medication chart 
Morphine elixir PO

> 6 mths:  
0.5 – 1mg/kg 
(Max dose 30mg)

< 6 mths: 
0.25 – 0.5mg/kg
3 – 4 hourly PRN

Please write up a range rather than a single amount

Can be given one hour after Codeine

Paracetamol PO 15mg/kg 6 hourly
(regular, Max dose = 1g)
Discuss with pharmacy in < 1 mth olds
Ibuprofen PO 10mg/kg 6 hourly
(regular/PRN)
Not in < 3 mth olds
Oxycodone PO 0.05 – 0.1mg/kg
4 hourly PRN
 
 Ondansetron IV /PO 0.1 – 0.2mg/kg
8 – 12 hourly PRN
(Max dose = 8mg)
Maximum 24mg in 24 hrs

*A recent TGA review has recommended avoiding codeine in children < 12years and in children. 

We want your feedback!

Help us provide guidelines that are useful to you, the clinician.

Give feedback here