Pediatric emergency medicine trisk 1067

2 Breathing Equipment 2.1 Oxygen tank with flow meter 2.2 Oxygen tubing 2.3 Nasal cannula 2.4 Oxygen reservoir masks 2.5 Face masks (infant to adult sizes) 2.6 Bag-valve mask with O2 reservoir (pediatric, adult) 2.7 Pulse oximeter 2.8 Nebulizer and administration equipment Circulation Equipment 3.1 Cardiac board 3.2 IV catheters 3.3 Intraosseous needles 3.4 Normal saline in 5% dextrose (D5NS) 3.5 Normal saline solution 3.6 Sphygmomanometers—cuffs 3.7 Tourniquets 3.8 Chlorhexidine or Betadine swabs 3.9 Alcohol swabs 3.10 Tape 3.11 Syringes 3.12 Arm boards Emergency Drugs 4.1 Activated charcoal 4.2 Atropine 4.3 Dextrose, 25% 4.4 Epinephrine 0.1 mg/mL (1:10,000) and mg/mL (1:1,000); Autoinjectors 0.15 mg, 0.30 mg 4.5 Midazolam 4.6 Naloxone Other Equipment 5.1 Gloves, non latex (small, medium, large) 5.2 Resuscitation cart checklist 5.3 Semirigid cervical collars (pediatric, adult) 5.4 Splints, slings 5.5 Nasogastric tubes 5.6 Protective eyewear 5.7 Broselow TapeTM or wall chart Suggested Readings American Academy of Pediatrics; Committee on Pediatric Emergency Medicine; American College of Emergency Physicians; et al Joint policy statement–guidelines for care of children in the emergency department Pediatrics 2009;124(4):1233–1243 Feldman M Guidelines for paediatric emergency equipment and supplies for a physician’s office Paediatr Child Health 2009;14(6):402–404 Remick K, Gausche-Hill M, Joseph MM, et al Pediatric readiness in the emergency department Ann Emerg Med 2018;72(6):e123–e136 CHAPTER 129 ■ PROCEDURAL SEDATION JEANNINE DEL PIZZO, JOEL A FEIN, STEVEN M SELBST INTRODUCTION Injuries and painful medical conditions are common among children presenting to the emergency department (ED) Some medical conditions may require a procedure which itself may be painful or require a child to be absolutely still ED physicians are obligated to manage pain appropriately and safely, and ensure that procedures are performed under conditions that limit harm to the patient Performing procedural sedation and analgesia (PSA), when indicated, is a necessary skill for the ED physician, and is essential to providing comfort and quality care to children and their families BACKGROUND Barriers to Treatment of Pain in Children Historically, pain in children has been underrecognized and undertreated While improvements have been made, pediatric pain is still not always addressed satisfactorily in the ED and the reason is multifaceted Adult patients who clearly indicate that they are in pain generally get a direct response from a physician, whereas a young child who is crying or whimpering may not Crying or whimpering may be developmentally normal in the absence of pain and may reflect hunger, fatigue, anxiety, or displeasure, for example Additionally, young children cannot describe or localize their pain, therefore, it is sometimes ignored or presumed not to exist Some ED physicians avoid giving adequate analgesics to children because they are unfamiliar with medication options in the pediatric population, are uncomfortable with side effects, or mistakenly fear it will lead to drug addiction Untoward side effects, such as hypotension and respiratory depression, are commonly feared consequences of opioid use in children Although these fears may be legitimate, respiratory depression and hypotension are unlikely to occur if proper protocols are adhered to, and should be manageable in the ED in the event they occur Racial, ethnic, and cultural factors also influence pain and its management in the ED There is evidence that for long-bone fractures and abdominal pain, children of Black and Hispanic background are less likely to receive opioid analgesia than White children Furthermore, in a busy ED, physicians are often forced to concentrate on other aspects of resuscitation and care before managing pain Plans for pain control, therefore, may be overlooked because of other priorities Some physicians avoid analgesics because they not want to mask symptoms Topical anesthetics may be avoided because it is inconvenient to wait for them to take effect This can delay care, so some physicians may underuse analgesics and convince a young child that a painful procedure or repositioning of an extremity fracture will hurt only “for a minute.” Forceful restraint (instead of medication) is then used, and more pain is inflicted on an already uncomfortable child Impact of Pain and Importance of Successful Pain Management Emergency physicians must understand that pain is an individual experience and many factors contribute to the degree of pain that a child experiences for any given condition Children of all ages can experience pain; it is believed that even neonates by 26 weeks’ gestation respond to tissue injury with specific behavior and with autonomic, hormonal, and metabolic signs of distress Newborns feel pain and react to painful stimuli (e.g., circumcision) with wiggling motions and crying Young children often have an exaggerated fear of needles, while older children may be better able to understand the need for a painful procedure; they are usually less anxious and better able to tolerate the inflicted pain However, an older child may have a better understanding of the significance of an injury or an illness that could cause depression, anxiety, and more pain Similarly, parental response (anxiety or reassuring calm) may affect a child’s perception of pain Caregivers can experience elevated heart rate, blood pressure, and anxiety during painful procedures Not surprisingly, parental distress–promoting behaviors may increase childhood distress Other psychological factors, such as the child’s emotional state, personality traits, gender, or cultural background, may impact their anxiety, and this can also alter the degree of pain Some children seem to have a hypersensitivity to pain, whereas others tolerate it well Certain genotypes, such as the CYP2D6 polymorphisms and opioid receptor OPRM1, can mediate the metabolism and efficacy of certain ... of Pediatrics; Committee on Pediatric Emergency Medicine; American College of Emergency Physicians; et al Joint policy statement–guidelines for care of children in the emergency department Pediatrics... paediatric emergency equipment and supplies for a physician’s office Paediatr Child Health 2009;14(6):402–404 Remick K, Gausche-Hill M, Joseph MM, et al Pediatric readiness in the emergency department... INTRODUCTION Injuries and painful medical conditions are common among children presenting to the emergency department (ED) Some medical conditions may require a procedure which itself may be painful