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ER60 Emergency Medicine
Presentation of Neglect
• Failure to thrive, developmental delay
• Inadequate or dirty clothing, poor hygiene • Child exhibits poor attachment to parents
Procedures that may Require Sedation
• Setting fractures
• Reducing dislocations
• Draining abscesses
• Exploring wounds/ulcers/superficial
infections
• Endoscopic examination
• Reduce patient anxiety/agitation for
imaging/procedures
Common Medications Toronto Notes 2019 Child Abuse and Neglect
• seePediatrics,P14
• obligation to report any suspected/known case of child abuse or neglect to CAS yourself (do not
delegate)
• documentinjuries
• considerskeletalsurveyx-rays(especiallyinnon-ambulatorychild),ophthalmologyconsult,CThead • injurypatternsassociatedwithchildabuse
■ HI: torn frenulum, dental injuries, bilateral black eyes, traumatic hair loss, diffuse severe CNS injury, retinal hemorrhage
■ Shaken Baby Syndrome: diffuse brain injury, subdural/SAH, retinal hemorrhage, minimal/no evidence of external trauma, associated bony fractures
■ skin injuries: bites, bruises/burns in shape of an object, glove/stocking distribution of burns, bruises of various ages, bruises in protected areas
■ bone injuries: rib fractures without major trauma, femur fractures age <1 yr, spiral fractures of long bones in non-ambulatory children, metaphyseal fractures in infants, multiple fractures of various ages, complex/multiple skull fractures
■ GU/GI injuries: chronic abdominal/perineal pain, injury to genitals/rectum, STI/pregnancy, recurrent vomiting or diarrhea
Common Medications
Table 41. Commonly Used Medications
Drug
Acetaminophen Activated charcoal ASA
β-blockers (metoprolol)
Diazepam
Enoxaparin Epinephrine
Fentanyl Flumazenil
Furosemide (Lasix®)
Glucose Haloperidol
Ibuprofen Insulin
Ipratropium bromide
Lidocaine with epi Lidocaine w/o epi Lorazepam
Dosing Schedule
325-650 mg PO q4-6h prn 30-100 g PO in 250 mL H2O
325-650 mg PO q4h max 4g/d stroke/MI risk: 81-325 mg PO OD 160 mg chewed
5 mg slow IV q5min x 3 if no contraindications
anxiety: 2-10 mg PO tid/qid
alcohol withdrawal: 10-20 mg PO/IV q1h titrated to signs/symptoms
1 mg/kg SC bid
anaphylaxis: 0.1-0.5 mg IM; can repeat q10-15min
0.5-1.0 μg/kg IV
0.3 mg IV bolus q5min x 3 doses
CHF: 40-80 mg IV HTN: 10-40 mg PO bid
0.5-1.0 g/kg (1-2 mL/kg) IV of D5OW
2.5-5.0 mg PO/IM initial effective dose 6-20 mg/d
200-800 mg PO tid prn max 1,200 mg/d
bolus 5-10 U (0.2 U/kg) then 5-10 U (0.1 U/kg) per h
2-3 puffs inhaled tid-qid, max 12 puffs/d
max 7 mg/kg SC max 5 mg/kg SC
anxiety: 0.5-2 mg PO/IM/IV q6-8h
status epilepticus: 4 mg IV repeat up to q5min
Indications
Pain control Poisoning/overdose
Pain control
Prevention of adverse cardiac events ACS
Acute MI
Anxiety
Alcohol withdrawal
Acute MI Anaphylaxis
Procedural sedation
Reversal of procedural sedation
CHF HTN
Hypoglycemia/DKA
Psychosis
Cannabis Hyperemesis Syndrome
Mild to moderate acute pain
Analgesic and anti-inflammatory properties
Hyperglycemia
Asthma
Local anesthetic Local anesthetic
Anxiety
Status epilepticus Alcohol withdrawal
Procedural sedation
Comments
Max 4 g daily
Efficacy and safety are case-dependent and are a source of debate
Max 1 mg/dose
Very short acting narcotic (complication=apnea)
Benzodiazepine antagonist
Can cause seizures/status epilepticus in chronic benzodiazepine users
Monitor for electrolyte imbalances
Monitor for side effects if prescribing to a patient with Parkinson's disease (extrapyramidal side effects); results in CNS depression
Monitor blood glucose levels
Consider K+ replacement, also measure blood glucose levels before administration
Contraindications include: peanut/soy allergy Caution with narrow-angle glaucoma
Not to be used in fingers, nose, toes, penis, ears
Short acting benzodiazepine (complication=apnea
when used with narcotic)
Fentanyl and midazolam often used together for procedural sedation
Midazolam
50 μg/kg IV