• Initiate assessment and observation forms.
  • Give patient and/or carer advice sheet.
  • Give intra-nasal alfentanil according to protocol and label child with “I’ve had IN alfentanil”.

1. Establish IV access if required

2. Monitor for side effects and effectiveness of pain management

3. Reassess pain scores

4. If pain score above 4 at 15mins consider alternative analgesics (e.g. IV morphine).

 

Respiratory depression: Earliest sign is sedation

  1. If sedation score 3 and RR below 8 then attempt to rouse and get senior help immediately.
  2. If no improvement with stimulation check ABC and…
  3. Consider Naloxone (Narcan) 2-100 mcg /kg *

*IV infusion is preferable to bolus if painful stimulus is still present. Can be given I/N if no IV access (same dynamics as IV).