An 8-year-old boy presents to the ED after falling at a?local playground

An 8-year-old boy presents to the ED after falling at a?local playground. His mother, who was with him at the?time of the injury, states that he was climbing out of a tree?when he slipped and fell. He landed on his outstretched?hands and is now complaining of right wrist pain. On?examination, he has no open wounds, and he has a normal?neurovascular examination, but he has an obvious deformity?of his right forearm. The child describes his pain as?7/10.

You ponder how best to treat the child?s severe pain?as quickly as possible….

What are your next steps?

Case Conclusion

To quickly address the 8-year-old boy’s arm pain, you ordered a dose of intranasal fentanyl at 1.5 mcg/kg. You instructed the nurse to draw up the IV formulation of fentanyl in a syringe and then attached an atomizer to the syringe. The nurse then administered half the dose into each of the patient?s nostrils. When you re-evaluated him 5 minutes later, his pain was significantly improved to 3/10. Eventually, the team was able to place an IV, and the boy?s fracture was successfully reduced while he was sedated with ketamine. The boy was discharged home, and dosing instructions for ibuprofen as needed for pain were given to his parents. You also provided a prescription for oxycodone for breakthrough pain, with specific instructions on its administration, storage, and disposal.

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Last Updated on November 1, 2021

2 thoughts on “An 8-year-old boy presents to the ED after falling at a?local playground

  1. Intranasal fentanyl 1.5 MCG/kg,
    Followed by a plaster backslab
    Then oral paracetamol and ibuprofen, timing depending on when I can fit in a reduction of the fracture.

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