PMG - Pediatric Pain Management

[00:00:07]I am an eBay spice and today we will be reviewing pain management in the acutely injured child in 2012 the American Academy of Pediatrics released a clinical report on the relief of pain and anxiety in pediatric patients in emergency medical systems in this report it was stated that there is a clear relationship between anxiety and pain it encouraged a multi-faceted approach to pain management and reviewed both pharmacologic and nonpharmacologic approaches in addition to the visual analog scale which can be used in older children there are validated pain scales that can be used in younger children the wong-baker faces scale has faces the correspond to the visual analog scale scores this can be used in the preschool and young school-age child the flacc scale can be used to assess pain in infants a study published in 2015 surveyed hospitalized children the children are asked to indicate the worst pain experience that they had in the preceding 24 hours the number one result was needle pokes and the number two was pain related to trauma or injury in the emergency setting there may not be much one can do to prevent pain with needle pokes if available a topical vapor coolant spray is an option it is beneficial to have someone who can talk to the child during the initial trauma evaluation Child Life if available can explain to the child what is going on utilize whomever you have available if you don't have child life having the parent present during the trauma evaluation can be very helpful for the anxious child this only works if the parent is not disruptive lastly distraction can help an anxious or injured child whether it's talking about their favorite superhero or pulling out a cell phone to play a cartoon video children can be calm during a stressful time there are many options to treat pain in children acetaminophen and NSAIDs are non narcotic options morphine and fentanyl can be administered intravenously fentanyl can also be given intranasally which is a good option in the acute pain setting if you are concerned about potential side effects from administering narcotics and children you can always give a smaller dose and redose if needed avoid intramuscular medications as the injections are quite painful themselves a recent study published in 2019 looked at intranasal ketamine versus intranasal fentanyl for pain control in extremity injuries the results demonstrated the ketamine is non inferior to fentanyl and can provide a non-narcotic option for pain management in this setting adverse events were minor in both groups drowsiness dizziness and an unpleasant taste were reported there are many studies that demonstrate that adequate pain control is associated with lower rates of PTSD following severe trauma the bottom line don't ignore pain in the acutely injured child and please don't be afraid to treat it thank you you