Most common ER pediatric meds

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Hello.

I work in an emergency department that sees mostly adults but we get pediatrics on occasion. I wanted to know which meds are most common for peds in the ER, specifically the ones I should administer with caution. (I know all meds should be administered with caution)

Thanks.

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The most commonly used PEDs meds are pretty low risk. Tylenol, ibuprofen, albuterol, prednisolone, zofran, amoxicillin, decadron, racemic epinephrine. IV fluids (NSS, D5NS or D5 1/2NS), morphine for severe pain. Ampicillin, gentamycin, acyclovir for neonatal fevers. Ativan, diastat, or IM versed for seizures. Mag for bad asthma. LET, LMX, or EMLA for topical numbing.

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Thanks!!

This helps a lot.

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Specializes in Emergency Nursing.

I don't work in the ED. I work in Adult Med/Surg but I used to be a tech. in a Pediatric ED. HiddencatRN hit on some of the big time meds. One I would admin. with caution in the Pedi. population is Toradol. It is not recommended for children but since it is used often for adults I have seen it ordered in regular EDs that serve Adults/Children. Although Toradol isn't recommended for children I have seen it used in 16 - 17 year olds on rare occation (usually only 1 dose.)

!Chris :specs:

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We use toradol frequently in pediatrics. It's a godsend for sickle cell pain and migraines. The formulary (lexicomp) we use doesn't caution against it.

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Specializes in Pediatric/Adolescent, Med-Surg.
I don't work in the ED. I work in Adult Med/Surg but I used to be a tech. in a Pediatric ED. HiddencatRN hit on some of the big time meds. One I would admin. with caution in the Pedi. population is Toradol. It is not recommended for children but since it is used often for adults I have seen it ordered in regular EDs that serve Adults/Children. Although Toradol isn't recommended for children I have seen it used in 16 - 17 year olds on rare occation (usually only 1 dose.)

!Chris :specs:

Chris, I have done peds and adults and I have seen tordol used more frequently with children than with adults. With sickle cell, migraines, or any sort of inflammatory pain, Tordol can work wonders for kids. Because of the risk of bleeding, it is often contraindicated in a lot of the elderly population. Most hospitals have a policy about how many doses of tordol you can receive in a 30 day period, and once you have max'ed out your tordol doses the patient would be switched to Motrin.

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Specializes in ER/Trauma.

I would only add ketamine to this list. In Peds, this drug is one of the go meds for moderate sedation procedures.

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Specializes in Emergency/Cath Lab.

I still get nervous with morphine. I always give half the ordered dose, wait assess then give the rest. Seen one too many times of nurses just push it like on adults and then the kid is gorked.

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As long as you give a weight appropriate dose and aren't pushing it too fast, morphine is safe in kids. Children are more likely to be undertreated for pain than snowed. I've had many chats with residents on not fearing morphine.

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Specializes in Emergency/Cath Lab.
As long as you give a weight appropriate dose and aren't pushing it too fast, morphine is safe in kids. Children are more likely to be undertreated for pain than snowed. I've had many chats with residents on not fearing morphine.

Its mainly from my inexperience with the kiddos. I am becoming more and more comfortable with them, but it is taking time and I find that I am becoming better with confidence with them. All in due time. But thanks for that :)

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Specializes in Emergency Nursing.
We use toradol frequently in pediatrics. It's a godsend for sickle cell pain and migraines. The formulary (lexicomp) we use doesn't caution against it.

Chris, I have done peds and adults and I have seen tordol used more frequently with children than with adults. With sickle cell, migraines, or any sort of inflammatory pain, Tordol can work wonders for kids. Because of the risk of bleeding, it is often contraindicated in a lot of the elderly population. Most hospitals have a policy about how many doses of tordol you can receive in a 30 day period, and once you have max'ed out your tordol doses the patient would be switched to Motrin.

Sorry, I haven't been on this site in a while so I haven't got a chance to respond. I have looked at a few different medication references and what they all noted was "the safety of using Toradol in the Pediatric population has not been established" and I believe that is why most of our ED Physicians would not order it for our kids. With that being said, there were cases where we would see a dose (or maybe two doses) of Toradol ordered but it tended to be for older teenagers and kids in Sickle Cell Crisis. I think the use of Toradol in the Pediatric population is largely based on the physician (or group of physicians) and your own hospital's policies. To the OP, add it to your list of meds. to know about but be aware of potential safety concerns.

!Chris :specs:

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Specializes in Emergency.
I would only add ketamine to this list. In Peds, this drug is one of the go meds for moderate sedation procedures.

I would also add that for pediatric moderate sedations (only MD can push IV ketamine, but RN draws it up and attaches syringe to IV with tubing clamped), versed and atropine are frequently ordered along with ketamine. Versed helps to relax the patient and decrease hallucinations 2/2 ketamine. Atropine helps decrease secretions and prevent vagal stimulation (pt usually becomes a little tachy).

Also, simethicone (mylicon, gas-x) was frequently ordered for kids even if there were no GI symptoms or complaints. Especially when Motrin was ordered because it helps coat the upper GI tract.

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