Can a 14-year-old male with second-degree facial burns on the chin, cheek, and parts of the neck receive 60 mg of intramuscular (IM) Toradol (ketorolac)?

From the Guidelines

I strongly advise against administering 60 mg of IM toradol (ketorolac) to a 14-year-old male with second-degree facial burns, as the maximum recommended dose for adolescents is typically 30 mg IM as a single dose. The management of severe thermal burns in the acute phase, as discussed in the study published in Anaesthesia in 2020 1, emphasizes the importance of multimodal analgesia and titration of analgesic medications based on validated comfort and analgesia assessment scales. However, the specific dosage of ketorolac for adolescents is not mentioned in this study.

According to the study published in Pediatrics in 2012 1, optimal pain management in pediatric patients requires expeditious pain assessment and rapid administration of systemic pain medication, and adjunctive pain medications such as nonsteroidal anti-inflammatory drugs can be used judiciously in children with pain. However, the study also highlights the importance of considering potential adverse effects such as antiplatelet activity, gastrointestinal tract toxicity, and renal toxicity.

Key considerations for pain management in this patient include:

• Assessing the severity of burns and the patient's weight to determine the appropriate dose of analgesic medication
• Evaluating potential contraindications and considering alternative pain management strategies
• Monitoring for complications such as infection, fluid loss, and adverse effects of analgesic medications
• Providing comprehensive care including wound care and follow-up evaluation

The patient should be evaluated by a healthcare provider who can determine the most appropriate pain management strategy for this specific situation, taking into account the patient's individual needs and potential risks.

From the FDA Drug Label

Patients <65 years of age: One dose of 60 mg For patients ≥65 years of age, renally impaired patients (see WARNINGS), and patients less than 50 kg (110 lbs): The recommended dose is 15 mg ketorolac tromethamine injection every 6 hours. The maximum daily dose for these populations should not exceed 60 mg

The patient is a 14-year-old male, which means he is less than 65 years of age. According to the drug label, for patients less than 65 years of age, a single dose of 60 mg of IM ketorolac can be administered. There is no specific contraindication for patients with facial 2nd degree burns. Therefore, a 14-year-old male with facial 2nd degree burns on the chin, cheek, and parts of the neck can have 60 mg of IM toradol 2.

• Key considerations:
  • The patient's weight is not provided, but since the patient is 14 years old, it is likely that the patient weighs more than 50 kg (110 lbs).
  • The patient should be monitored for any potential side effects, especially renal effects, as hypovolemia should be corrected prior to the administration of ketorolac tromethamine.

From the Research

Dosage of IM Toradol for a 14-year-old Male with Facial Burns

• The provided studies do not directly address the dosage of IM Toradol for a 14-year-old male with facial burns.
• However, study 3 compares the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and paracetamol in the treatment of acute renal colic, and suggests that NSAIDs, such as Toradol, can be effective in managing acute pain.
• Study 4 discusses the risk of acute renal failure associated with parenteral ketorolac, a type of NSAID, and found that the risk is low when used for less than 5 days.
• Study 5 reviews the use of major analgesics in patients with renal dysfunction and suggests that NSAIDs, such as Toradol, can be used with caution in patients with impaired renal function.
• The dosage of 60 mg of IM Toradol is not explicitly mentioned in the provided studies, but study 6 does not provide information on the use of Toradol in the management of facial burns.

Considerations for Administration

• When administering IM Toradol to a 14-year-old male with facial burns, it is essential to consider the patient's weight, renal function, and potential interactions with other medications.
• Study 7 discusses the use of paracetamol in pain management and highlights the importance of considering individual patient factors, such as liver disease or malnourishment, when selecting a pain management strategy.
• The decision to administer 60 mg of IM Toradol should be made by a qualified healthcare professional, taking into account the patient's specific needs and medical history, as well as the potential risks and benefits of the medication 5, 3, 4.