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IN THE NAME OF ALLAH
THE MOST BENEFICENT
THE MOST MERCIFUL
DRUGS DILUTION & PAIN
MANAGEMENT IN
PEDIATRICS
LEARNING OBJECTIVES:
▸ At the end of this session we will be able to know the basics
of drug dilutions
▸ We will also be able to understand the basics of pain and its
management in pediatrics .
TEXT
PAIN MANAGEMENT IN PEDIATRICS
TEXT
WHAT IS PAIN ??
TEXT
PAIN ( FIFTH VITAL SIGN)
▸ International association for the study of pain (IASP)
“An unpleasant sensory and emotional experience associated
with actual and potential tissue damage”.
TEXT
PHYSIOLOGY OF PAIN :
TEXT
TEXT
TEXT
TEXT
CLASSIFICATION OF PAIN:
▸Acute pain ( subsides as tissue
is healed )
▸Chronic pain (>6months of
duration)
▸Malignant or non malignant
▸Based on anatomical location
Pathophysiological
Nociceptive pain ( Somatic or visceral)
Neuropathic pain (abnormal processing of sensory input )
TEXT
CHILD IN PAIN :
▸ Mostly under treated
▸ Painful experience for child and family
▸ Effects quality of life
▸ Increases rates of hospital admissions
TEXT
ASSESSMENT OF PAIN IN
PEDIATRICS
▸ Appropriate intervention
▸ Accurate evaluation
▸ Observational and behaviour
assessment tool
NEONATES
PAIN RATING
SCALE (NPR-
S)
FLACC
FOR
NEONATES
A. Face
B. Legs
C. Activity
D. Cry
E. Consolability
FLACC
TYPE A
QUOTE
HERE.
Johnny Appleseed
COMFORT
BEHAVIOURAL
SCALE
TEXT
1. Alertness
2. Calmness
3. Respiratory response or crying
4. Body movements
5. Facial tension
6. Muscle tone
TEXT
PAIN SCORE 6-30
▸ Intervene when COMFORT-B scores of 17 or higher are
combined with VAS pain score of 4 or higher .
PAIN MANAGEMENT
▸ Paediatricians often user treat
children’s pain
▸ When initiating pain medications ,
avoid combination products
▸ Constantly re-assess you pain pan
(Is it working ? . Any side effects??
NON
PHARMAC
OLOGICAL
PAIN
MANAGEM
ENT
Physical
‣ Massage
‣ Heat and cold
‣ Acupuncture
Behavioural
‣ Relaxation
‣ Art and play
therapy
‣ Biofeedback
Cognitive
‣ Distraction
‣ Imagery and
hypnosis
TEXT
PAIN MEDICATIONS
▸ Acetaminophen :
▸ PO: 10-15mg/kg every 4-6 hours
▸ Ibuprofen:
▸ PO:05-10 mg /kg every 4-6 hours
(contraindicated in active GI
bleeding , hypersensitivity to NSAID
)
TEXT
KETOROLAC
▸ NSAID
▸ Available PO, IV, IM
▸ Potential opioid sparing effect
▸ Cannot be use for a long time
▸ No more than 24-72 hours in children less than 2 years
▸ No more than 5 days in children 2 and older
NON OPIOID
DRUGS :
TEXT
WHO ANALGESIC
LADDER
OPIOID DRUGS:
DRUG DILUTION
It is important for patient safety that you can :
▸ Accurately calculate an appropriate dose of drug for given
patient
▸ Prepare an accurate dilution of a given drug
SI UNITS
DEFINITION:
SI stands for system international and is
alternative name for the Matric system of
measurement
The main units are as following:
1. Weight (kg)
2. Volume (Litter)
3. Amount of substance (mole)
EQUIVALENCES OF WEIGHT AND VOLUMES
★
★
★
★
TEXT
EQUIVALENCE OF VOLUME
✴1 Litre = 1000 millilitres
✴1 millilitre = 1000 microliters
DILUTION
S
‣ ANYTHING REPRESENTED IN AN X:Y (E.G. 1:1000)
FASHION , IS X GRAMS OF DRUG ( OR SOLUTE )
DIVIDED BY Y MILLILITRES OF SOLUTIONS
‣ E.G. 1:1000 OF AN EPINEPHRINE SOLUTION
CONTAINS 1G OF EPINEPHRIN IN 1000 ML OF THE
SOLUTION
TEXT
REMEMBER THAT 1ML OF WATER WEIGHS 1G SO
…..
100% SOLUTION CONTAINS 100G IN 100ML
THIS IS THE SAME AS 1:1 SOLUTION
TEXT
EXAMPLES:
▸ 10% Solution = 10g /100ml solution.
▸ 1%Solution =1g / 100ml solution
▸ 0.1% Solutions = .1g/100ml solution
▸ .01% Solution = .01g/100ml solution
TEXT
QUESTION
▸ How many milligrams of epinephrine are present in 10ml of a
1:1000 preparation?
TEXT
ANSWER
▸ 1000ml solution contains 1g (=1000mg) epinephrin
▸ So, 10ml will contain 10mg epinephrine
PAIN MANAGEMENT AND DRUG DILUTION PPT .pptx
PAIN MANAGEMENT AND DRUG DILUTION PPT .pptx

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PAIN MANAGEMENT AND DRUG DILUTION PPT .pptx