Responsible and Safe Use of Opioids in Children and Adolescents in the Emergency Department (Pain Management CME, Controlled Substances CME, Pharmacology CME, and Addiction Disorders CME) | Store
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Responsible and Safe Use of Opioids in Children and Adolescents in the Emergency Department (Pain Management CME, Controlled Substances CME, Pharmacology CME, and Addiction Disorders CME) -
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Responsible and Safe Use of Opioids in Children and Adolescents in the Emergency Department (Pain Management CME, Controlled Substances CME, Pharmacology CME, and Addiction Disorders CME)
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Publication Date: January 2023 (Volume 20, Number 1)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 01/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Pain Management credits, 4 Controlled Substances credits, 4 Pharmacology credits, and 1 Addiction Disorders CME credit, subject to your state and institutional approval.

Authors

Samina Ali, MD, FRCPC
Professor, Pediatrics and Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
Amy L. Drendel, DO, MS
Professor of Pediatrics, Medical College of Wisconsin; Medical Director, Emergency Department, Children’s Wisconsin, Milwaukee, WI

Peer Reviewers

Deepa R. Camenga, MD, MHS, FAAP
Associate Professor of Emergency Medicine, Pediatrics and Public Health, Yale Schools of Medicine & Public Health, New Haven, CT
Reuben J. Strayer, MD
Emergency Medicine and Addiction Medicine, Maimonides Health, Brooklyn, NY

Abstract

Untreated pain in childhood may have ramifications well into adulthood. Opioid medications have an important role in care for moderate to severe pain that cannot be relieved by first-line interventions, but clinicians must approach opioid use in the emergency department in an evidence-based, socially responsible manner. This issue reviews evidence-based approaches to assessment and management of pain in children and adolescents, with a focus on optimizing nonopioid pain management as a first approach and using opioid medications safely, when appropriate. Recommendations are provided for safer opioid prescribing, including assessment of risk factors for opioid misuse, careful family counseling and education, and suggested prescribing limits. Prescription and use of naloxone in the emergency department and as take-home kits are also discussed.

Case Presentations

CASE 1
A 10-year-old girl is brought in via wheelchair by her mother…
  • The girl is developmentally delayed, nonverbal, writhing and moaning, and keeps batting your hands away when you try to examine her. Her temperature is 39.2°C, and her heart rate 150 beats/min. Her mother is tearful, saying that she has never seen her daughter in so much pain.
  • You wonder how you can quickly ease the child's pain so you can figure out what is going on…
CASE 2
A 2-year-old boy with known sickle cell disease is carried into the emergency department triage area by his father…
  • The boy is curled up, still, and tearful. He is afebrile, has a heart rate of 160 beats/min, and has pain with movement of his right upper extremity—the site of his typical vaso-occlusive pain crises. His parents have been treating him at home for the last 24 hours. They have been giving him ibuprofen and the oral opioid medication his hematologist has prescribed. They say they think the home treatment is not working.
  • You begin to think how you will treat this child’s pain quickly and effectively...
CASE 3
A 15-year-old girl fell while skateboarding and sustained a both-bone forearm fracture…
  • You successfully reduced her fracture in the ED and have arranged follow-up with orthopedics in 7 to 10 days. The girl is now ready to go home.
  • The family is asking what to do for pain, now and at home, since the sedation has worn off and her wrist is beginning to throb.
  • What medications should you recommend for at-home use, and how should you advise the family to use them?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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