Burns - Analgesia and dosing
Disclaimer
These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.
Read the full PCH Emergency Department disclaimer.
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Aim
To guide PCH ED staff in prescribing analgesia in patients with burns.
General principles
- 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
Severe |
Fentanyl |
Intranasal |
1.5 micrograms/kg via atomiser. 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
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Morphine |
IV |
0.05-0.1 mg/kg. Can repeat 5 minutely until effective |
If pain is severe, IV Morphine can be used in addition to IN Fentanyl |
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Oral medication (as below) |
PO |
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Give soon after first dose of Fentanyl or Morphine |
Mild to moderate |
Paracetamol |
PO |
15mg/kg (maximum dose = 1 gram) |
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Ibuprofen |
PO |
10mg/kg (maximum dose = 400mg) |
Not in <3 months old |
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Oxycodone |
PO |
0.05 - 0.2mg/kg (usual maximum dose 5-10mg) |
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Medication on the Burns Ward
After hours: when child is admitted to the Burns Ward between 2200-0800 hrs please chart the following on ward medication chart:
Morphine elixir |
PO |
<6 months: 0.25-0.5mg/kg 3-4 hourly PRN
>6mths: 0.5-1mg/kg (Max dose 30mg)
3-4 hourly PRN
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Please prescribe a range rather than single amount.
For dressing changes only. |
Paracetamol |
PO |
15mg/kg 6 hourly (regular, max dose = 1g) |
Discuss with pharmacy <3 months old |
Ibuprofen |
PO |
10mg/kg 8 hourly (regular, max dose = 400mg)
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For children >3 months age |
Oxycodone |
PO |
0.05-0.2mg/kg, 4 hourly PRN (usual maximum 5-10mg) |
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Ondansetron |
IV/PO |
0.15mg/kg 8 hourly PRN (max dose = 8mg) |
Maximum 2 doses |
Bibliography
- AMH Children’s Dosing Companion (2015) Australian Medicines Handbook Pty Ltd
- Textbook of Paediatric Emergency Medicine 2nd Edition Cameron Elesevier 2012
- Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier
Endorsed by: |
Drugs and Therapeutics Committee |
Date: |
Dec 2018 |
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