{
  "id": "medical/pediatric-pca-pump-override",
  "signature": "AI programs a pediatric PCA pump with adult lockout intervals for morphine, leading to respiratory depression in a 6-year-old",
  "signature_zh": "AI 以成人锁定间隔为 6 岁儿童编程儿科 PCA 吗啡泵，导致呼吸抑制",
  "regex": "morphine.*lockout.*(6|adult).*pediatric|PCA.*interval.*child",
  "domain": "medical",
  "category": "runtime_error",
  "subcategory": null,
  "root_cause": "Pediatric Patient-Controlled Analgesia (PCA) requires a minimum lockout interval of 8-10 minutes for morphine, not the adult standard of 6 minutes, because children metabolize opioids faster and have narrower therapeutic windows, risking respiratory depression.",
  "root_cause_type": "generic",
  "root_cause_zh": "儿科患者自控镇痛 (PCA) 要求吗啡的最小锁定间隔为 8-10 分钟，而非成人标准的 6 分钟，因为儿童代谢阿片类药物更快且治疗窗口更窄，存在呼吸抑制风险。",
  "versions": [
    {
      "version": "GE Healthcare Aisys CS2 v8.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Baxter PCA Syringe Pump v3.4",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Smiths Medical CADD-Solis v5.2",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Higher bolus doses increase peak serum concentration and risk of apnea without addressing the underlying clearance mismatch",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Lockout interval is independent of concentration; a lower concentration with the same interval still allows too frequent dosing in children",
      "fail_rate": 0.85,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Eliminating lockout removes the safety mechanism and can lead to cumulative overdose if the child presses the button repeatedly",
      "fail_rate": 0.95,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Set lockout interval to 10 minutes and bolus dose to 0.02 mg/kg for morphine PCA in a 6-year-old; verify using the Broselow tape or weight-based pediatric nomogram",
      "success_rate": 0.88,
      "how": "Set lockout interval to 10 minutes and bolus dose to 0.02 mg/kg for morphine PCA in a 6-year-old; verify using the Broselow tape or weight-based pediatric nomogram",
      "condition": "",
      "sources": []
    },
    {
      "action": "Use a dedicated pediatric PCA protocol that enforces a minimum lockout of 8 minutes and a maximum 1-hour limit of 0.1 mg/kg; program pump with 'Pediatric Mode' if available",
      "success_rate": 0.92,
      "how": "Use a dedicated pediatric PCA protocol that enforces a minimum lockout of 8 minutes and a maximum 1-hour limit of 0.1 mg/kg; program pump with 'Pediatric Mode' if available",
      "condition": "",
      "sources": []
    },
    {
      "action": "For a 6-year-old weighing 20 kg, program: bolus = 0.4 mg, lockout = 10 min, 1-hr limit = 2 mg; document in MAR and double-check with a second nurse",
      "success_rate": 0.95,
      "how": "For a 6-year-old weighing 20 kg, program: bolus = 0.4 mg, lockout = 10 min, 1-hr limit = 2 mg; document in MAR and double-check with a second nurse",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Set lockout interval to 10 minutes and bolus dose to 0.02 mg/kg for morphine PCA in a 6-year-old; verify using the Broselow tape or weight-based pediatric nomogram",
    "Use a dedicated pediatric PCA protocol that enforces a minimum lockout of 8 minutes and a maximum 1-hour limit of 0.1 mg/kg; program pump with 'Pediatric Mode' if available",
    "For a 6-year-old weighing 20 kg, program: bolus = 0.4 mg, lockout = 10 min, 1-hr limit = 2 mg; document in MAR and double-check with a second nurse"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/pain-management/pediatric-pca-guidelines.pdf",
  "official_doc_section": null,
  "error_code": "PCA-ERR-001",
  "verification_tier": "ai_generated",
  "confidence": 0.85,
  "fix_success_rate": 0.88,
  "resolvable": "true",
  "first_seen": "2024-03-14",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}