Background: There has been lots of research published in past years on how to minimize pain and anxiety in children brought to the ED. Unfortunately, as we all know there is often a lag time from research publication to clinical application. It has been my experience that health care professionals tend to provide inconsistent and inadequate pain control for children. In this episode of REBEL Cast we are going to interview Sebrina Perkins, a pediatric emergency medicine physician working for the Greater San Antonio Emergency Physicians (GSEP) group, on pediatric pain management pearls....Read More
Background: Ketorolac is a commonly used parenteral analgesic in the Emergency Department (ED) for a variety of indications ranging from musculoskeletal injuries to renal colic. This non steroidal anti-inflammatory drug (NSAID) is available in oral, intranasal and parenteral routes. Ketorolac has a number of side effects including nausea, vomiting, gastrointestinal bleeding and renal insufficiency. The risk of GI bleeding appears to be related to the use of higher doses and prolonged use. As with all NSAIDs, the drug has an analgesic ceiling - the dose at which additional dosing will not provide additional analgesia but can lead to more side effects. The current FDA dosing is 30 mg intravenously and 60 mg intramuscularly for patients < 65 years of age. However, the necessity of these doses is unclear and prior studies have demonstrated efficacy of considerably lower doses. The use of lower doses, if effective, may mitigate the potential for harm.