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Paediatric pain relief fracture — DipIMC MCQ

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HardPaediatric and Obstetric EmergenciesPaediatric pain relief fractureDipIMC

A 12-year-old has a painful isolated forearm fracture. He is alert, neurovascularly intact, cannot tolerate oral medicine and IV access is not otherwise required. Which analgesic route should be considered?

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Correct answer: D — Give weight-based atomised intranasal diamorphine or ketamine

The best answer is “Give weight-based atomised intranasal diamorphine or ketamine”. NICE advises considering atomised intranasal diamorphine or ketamine when IV access has not been established in major trauma, using weight-based dosing and local governance. This route can provide timely analgesia without inserting an IV solely for pain treatment. Midazolam is sedation rather than analgesia, transdermal fentanyl is too slow, and fixed adult parenteral doses are unsafe in a child.

Reference: NICE NG39, Major trauma: https://www.nice.org.uk/guidance/ng39/chapter/recommendations