Pediatric emergency medicine trisk 4308 4308

of electrical devices or other possibly dangerous items should not be
permitted for at least 8 hours.

DISCHARGE MEDICATIONS
Children in the ED with painful medical conditions or injuries may continue
to experience pain after discharge home. Below is a brief summary of
frequently used oral outpatient analgesics for mild to moderate pain.

Acetaminophen
Acetaminophen acts centrally on nonopioid receptors in the brain to inhibit
prostaglandin synthetase. Acetaminophen is a good choice for pain
associated with minor trauma or otitis media because it is well tolerated and
comes in liquid form, making it easy to give to young children. In addition,
acetaminophen does not cause bleeding and is unlikely to cause
bronchospasm in asthmatics. It is dosed at 10 to 15 mg/kg/per dose every 4
hours (with no more than 5 doses/24 hours) and takes effect in 20 to 40
minutes, with a peak effect in 2 hours. Rectal administration produces
delayed and variable uptake. Higher doses may be needed, but clearance
may be prolonged so the rectal dose interval should be extended to 6 or 8
hours. Single rectal doses of 20 mg/kg produced safe plasma concentrations
in preterm neonates. In general, high dosages of acetaminophen are usually
well tolerated, but therapy in children should not exceed 75 mg/kg/day (60
mg/kg/day in infants and newborns). Acetaminophen has no antiinflammatory effects, and therapeutic doses rarely are associated with side
effects in children; overdose, however, can cause liver toxicity. Over-thecounter acetaminophen is available in several different concentrations, so
parents must be carefully advised about correct dosing.

NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are potent inhibitors of the
cyclooxygenase (COX) pathway and they prevent the formation of
prostaglandin, a known mediator of pain, fever, and inflammation. NSAIDs
are excellent choices for treating minor pain, such as headache,

dysmenorrhea, or musculoskeletal injuries. NSAIDs are subject to a ceiling
effect, in which a maximum dose is achieved, beyond which there is no
additional analgesic effect. Advantages of NSAIDs are that they are
nonaddictive and do not cause respiratory or cardiac depression. NSAIDs