Paediatric Supracondylar Fracture with Down Syndrome

You are on call at the Children's Hospital. At 1730 hours you are asked to review a 7-year-old girl with Down syndrome in the Emergency Department (ED) who sustained a supracondylar fracture of the left humerus whilst playing on a trampoline at a birthday party. She is booked on the emergency list for closed reduction and percutaneous pinning of the fracture. On your arrival in ED you are informed that the girl has received intranasal fentanyl 50 mcg following one unsuccessful attempt to gain IV access. The dose of fentanyl was based on a weight of 31 kg which had been documented in the girl's case notes at a recent outpatient clinic appointment.