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Pediatric Analgesia - Dr. Fox

10/16/2014

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Why it Matters

Picture
  • Patient Satisfaction - Pain management is a very prominent driver of patient satisfaction.
  • Our Satisfaction - Caring for our patients and alleviating discomfort is part of why we got into this job. 
  • Departmental Function - Patients in pain slow your department down! 

  • It is often a slippery slope between being Compassionate and becoming Cruel.
  • Simple strategies can help you from sliding down this sadistic hill.

Intranasal Fentanyl

  • Intranasal Fentanyl is as efficacious as IV Morphine... but doesn't require the IV.
  • This means it can be started soon after initial evaluation.
  • Dose = 1-2 micorgrams/kg
  • Don't use more than 0.3 mL per nostril at one time.
  • Use an atomizer!
  • http://pedemmorsels.com/intranasal-analgesia/

Nitrous - It's NOt Just for Dentists!

  • Nitrous works great - it gives analgesia, anxiolysis, and anesthesia.
  • It is nearly the ideal sedative -- onset is rapid and offset is even more rapid.
  • It has minimal side-effects - nausea and vomiting.
  • Contra-indicated for patients with areas of entrapped air (ptx, bowel obstruction) and in pregnant women.
  • Can really help make those minor procedures (I+D, lac repairs, Lumbar punctures) easier.  
  • If the patient is giggling during your I+D, you will have a good day.
  • http://pedemmorsels.com/nitrous-oxide/

NEonates Feel Pain too!!

  • Consensus Statement for Prevention and Management of Pain in the Newborn (2001) states:
  • NEONATES DO FEEL PAIN.
  • NEONATES MAY HAVE GREATER SENSITIVITY TO PAIN.
  • NEONATES ARE MORE SUSCEPTIBLE TO LONG TERM EFFECTS OF PAIN.
  • Use LMX (or other topical lidocaine) along with oral sucrose to help manage the neonates pain during lumbar punctures!
  • This will help them as well as help you be more compassionate and likely improve your success rate!
  • http://pedemmorsels.com/neonatal-analgesia/
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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction