The right dose, the right cap, the right child — analgesic and antipyretic prescribing

Candidate brief

You are the paediatric registrar on the ward overnight. A six-year-old boy, 21 kg, has just been admitted after reduction and backslabbing of a displaced both-bone forearm fracture. He is tearful and guarding the arm, drinking small sips of water, and has a fever of 38.8 °C with a coryzal viral illness. The ward nurse asks you to confirm the analgesic and antipyretic plan and to calculate the doses. A medical student suggests alternating paracetamol and ibuprofen every two hours and offers aspirin for the fever. ^[2]

You have ten minutes to: confirm the weight and score the pain; choose and calculate the analgesic and antipyretic doses with the adult ceiling; take a position on the alternating suggestion and the aspirin offer; plan the opioid escalation and its monitoring if simple analgesia is inadequate; and prepare the discharge communication and safety-net. ^[2]