of electrical devices or other possibly dangerous items should not be permitted for at least hours DISCHARGE MEDICATIONS Children in the ED with painful medical conditions or injuries may continue to experience pain after discharge home Below is a brief summary of frequently used oral outpatient analgesics for mild to moderate pain Acetaminophen Acetaminophen acts centrally on nonopioid receptors in the brain to inhibit prostaglandin synthetase Acetaminophen is a good choice for pain associated with minor trauma or otitis media because it is well tolerated and comes in liquid form, making it easy to give to young children In addition, acetaminophen does not cause bleeding and is unlikely to cause bronchospasm in asthmatics It is dosed at 10 to 15 mg/kg/per dose every hours (with no more than doses/24 hours) and takes effect in 20 to 40 minutes, with a peak effect in hours Rectal administration produces delayed and variable uptake Higher doses may be needed, but clearance may be prolonged so the rectal dose interval should be extended to or hours Single rectal doses of 20 mg/kg produced safe plasma concentrations in preterm neonates In general, high dosages of acetaminophen are usually well tolerated, but therapy in children should not exceed 75 mg/kg/day (60 mg/kg/day in infants and newborns) Acetaminophen has no antiinflammatory effects, and therapeutic doses rarely are associated with side effects in children; overdose, however, can cause liver toxicity Over-thecounter acetaminophen is available in several different concentrations, so parents must be carefully advised about correct dosing NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) are potent inhibitors of the cyclooxygenase (COX) pathway and they prevent the formation of prostaglandin, a known mediator of pain, fever, and inflammation NSAIDs are excellent choices for treating minor pain, such as headache, dysmenorrhea, or musculoskeletal injuries NSAIDs are subject to a ceiling effect, in which a maximum dose is achieved, beyond which there is no additional analgesic effect Advantages of NSAIDs are that they are nonaddictive and not cause respiratory or cardiac depression NSAIDs