Category: MSK

Intranasal Fentanyl

There is was a national shortage of Intranasal Diamorphine therefore many departments are now more comfortable using Intranasal Fentanyl as a replacement for rapid provision of opioid analgesia in children.

  1. Intranasal (IN) fentanyl is a safe, non-invasive and effective analgesic for children with moderate to severe pain
  2. Fentanyl should be used in combination with non-pharmacological and other pharmacological pain management
  3. It can be used in conjunction with nitrous oxide for procedural sedation or prior to procedural sedation with ketamine

Dose is 1.5micrograms/Kg for the initial dose and 0.75micrograms/kg 10 minutes later if required.

Drug Delivery

Draw up the appropriate dose plus 0.1ml to allow for the dead space in the Mucosal Atomizer Device

Attach the MAD to the syringe

Sit the child at 45 degrees insert MAD loosely into the nostril and press the plunger

Doses greater than 0.5ml should be split between 2 nostrils

 

Contraindications

  • Blocked nose due to upper respiratory illness or epistaxis
  • Respiratory depression
  •  Hypovolaemia
  • Altered consciousness
  • Hypersensitivity to fentanyl
  •  Children below 1 year old

Full Intranasal Fentanyl SOP

Limping Child

This is a relatively common  presentation within the ED that has a myriad of possible diagnoses ranging from sprain to malignancy. One thing to remember is that patients and relatives will look for a traumatic reason for limb pain, and may link it to minor injuries that would not have caused it.  Read more

Knee (Cricket) splints

Used for a several types of knee injury, the knee splint provides support and comfort to the knee joint, whilst allowing for the patient to weight bear as appropriate.

The below indicative video demonstrates application of a leading brand.

The process is very similar with other manufacturers, but the specific manufacturer’s instruction should be adhered to for the splint applied.

Splints should be applied next to the skin, and certainly not over baggy clothing, as this may lead to movement of the splint, not providing the correct support.

Wool and Crepe Bandaging

Single and Double layer wool and crepe bandaging

Most commonly in the ED setting used to gently restrict movement of a joint, either due to injury of the sturcutres of the joint, or in order prevent stressing of wound closure.

The below shows a double wool and crepe bandage to the knee, which is also known as a Robert Jones bandage, the technique can be applied to other limbs, and for a single layer simply stop after the first layer of bandage is applied.

Robert Jones bandages are useful in the absence of appropriately sized knee splints, or if the patient is unable to tolerate a splint.

Note that although the text of the video states to finish mid-calf the bandage material should be extended past the calf to the top of the ankle as is the practice shown.