BASIC EMS Pediatric Pain Management Notes

Pain Signals
●​ Can be perceived pain, even without real tissue damage

Pain Process
●​ Transduction
○​ How nociceptors send pain signals
○​ When pain happens
○​ Releases chemical mediators to activate sensory neurons and nociceptors
■​ Chemical mediators are local and thus released immediately upon tissue
damage
●​ Transmission
○​ Release of APs
■​ Aβ: large and myelinated (fast)
■​ Aδ: small and myelinated (fastest)
■​ C: small and unmyelinated (slow)
○​ Converge in dorsal root ganglion
●​ Perception
○​ The feeling of “pain”
○​ Thalamus as relay station
■​ Source of damage → thalamus → CNS
●​ Modulation
○​ If pain gets better or worse
○​ Cortex and synapses in mid- and hindbrain
○​ Influences nociceptors in spinal cord
■​ Activation = more pain
○​ Pain diminishes over time by inactivation of nociceptors
■​ Or via pharmacological remedies

Neuropathy
●​ Unlike nociception, not chemical/mechanical stress
●​ Prolonged CNS damage
○​ Infection, diabetes, herpes, previous trauma
●​ Affects how pain-relieving drugs work
●​ “Harmful pain”
○​ Whereas nociception alerts body of a threat
●​ Chronic
●​ Often not localized

Pediatric Medication
●​ Fentanyl: 0.5-1µg/kg (max 50µg)
○​ Typically best option
●​ Morphine: 0.05-0.1mg/kg (max 5mg)
●​ Ketamine 0.1-0.3mg/kg (max 30mg)