I do intend to discuss unapproved or investigative use of commercial products or devices (= off-label).

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "I do intend to discuss unapproved or investigative use of commercial products or devices (= off-label)."

Transcription

1 "It's just feels like a little wasp sting, right?" State of the art in managing needle pokes and procedural pain in children Stefan J. Friedrichsdorf, MD, FAAP Medical Director, Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis/St. Paul, MN Disclosure Neither I nor any member of my immediate family has a financial relationship or interest with any proprietary entity producing health care goods or services related to the content of this CME activity. NO conflict of interest exists with my presentation I do intend to discuss unapproved or investigative use of commercial products or devices (= off-label). Current Research Support: NIH/NCI [1R25CA ]; Canadian Institutes of Health Research/Human Development, Child and Youth Health [185704]; Internal Research Grants Program (IRGP) Children s of MN Learning Objectives Appreciate incidence of procedural pain in children Review evidence for importance of managing procedural pain Describe importance of the non-negotiable components of state-of-the Art procedural pain management: topical anesthesia, positioning, and distraction (& sucrose if <12 months)

2 Procedural Pain in Children Procedural Pain: A call for action What are children most afraid of coming to our clinical service? Needle procedures (incl. vaccine injections) performed in childhood are a substantial source of distress It is estimated that up to 25% of adults have a fear of needles Guideline statement: management of procedure-related pain in children and adolescents.j Paediatr Child Health 2006;42(Suppl 1):S1-29. with most fears developing in childhood Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract 1995;41: with most fears developing in childhood Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract 1995;41: Procedural Pain: A call for action Untreated pain can have long-term consequences including preprocedural anxiety hyperalgesia needle fears avoidance of health care (including nonadherence with vaccination schedules Taddio A, Chambers CT, Halperin SA, et al. Inadequate pain management duringchildhood immunizations: the nerve of it. Clin Ther 2009;31(Suppl 2):S ) Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, et al. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. CMAJ : Canadian Medical Association journal 2010 Dec 14;182(18):E

3 Procedural Pain: A call for action Procedural Pain in the Neonate Critically ill infant may experience >480 painful procedures during NICU stay Barker DP (1995) Arch Dis Child Fetal Neonatal Ed 72:F47-8; Johnston CC (1997) Clin J Pain 13: Exposure to severe pain on NICU, without adequate treatment, has negative long-term consequences á morbity (hypoxia, coagulopathy, respiratory inccordination, increased intracranial pressure) á risk of IVH á mortality Anand KJS (1999) Arch Pediatr Adolesc Med 153:331-8 Pain in the Neonate: Why bother? Neonates at 33 weeks gestational age admitted to NICU experienced average of 10 painful procedures / day; 79 % were performed without any type of analgesia. Carbajal, R., Rousset, A., Danan, C., Coquery, S., Nolent, P., Ducrocq, S., et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. The Journal of the American Medical Association 2008, 157, Poorly managed pain has serious short- and long term consequences: Each painful event causes immediate physiological and behavioral instability Holsti L, Grunau RE, Oberlander TF, Whitfield MF. Specific Newborn Individualized Developmental Care and Assessment Program movements are associated with acute pain in preterm infants in the neonatal intensive care unit. d l () Significant relationship between physiological markers of neonatal pain and oxidative stress Slater L, Asmerom Y, Boskovic DS, Bahjri K, Plank MS, Angeles KR, et al. Procedural pain and oxidative stress in premature neonates. The journal of pain 2012 Jun;13(6): Repetitive procedural pain in preterm infants is associated with reduced early body growth and head circumference, after accounting for multiple medical confounders Vinall, J., S. P. Miller, et al. (2012). "Neonatal pain in relation to postnatal growth in infants born very preterm." Pain 153(7): Procedural pain: A call for action Pain ratings at 4-6 months routine vaccination higher for circumcised versus uncircumcised boys Taddio A (1994) Lancet, 344:291-2 Preterm infants: Poorer cognition and motor function associated with higher number of skin-breaking procedures Grunau RE, Whitfield MF, Petrie-Thomas J, Synnes AR, Cepeda IL, Keidar A, et al. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants. Pain May;143(1-2): Memory of previous painful experience has great influence on pain experience during subsequent procedures Versloot J, Veerkamp JSJ, Hoogstraten J: Children s self-reported pain at the dentist. Pain :389-94

4 How Do We Manage Needle Pain in Children? Well, it is not rocket surgery Joe Tribbiani Friends Essential Components of Procedural Pain Management Non-Negotiable components of a needle-poke protocol Positioning Integrative (non-pharmacological) therapies Topical Anesthesia 0-12 months: Sucrose Other Considerations Possibly other pharmacological approaches Consider appropriate sedation, if excellent analgesia cannot be achieved

5 Non-negotiable Components of Procedural Pain Management in Children 1/4 Positioning Pediatric Positioning in 1985 Positioning To reduce pain at the time of injection, do not place children in a supine position during vaccination (grade E recommendation, based on level I evidence). Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, et al. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. CMAJ : Canadian Medical Association journal 2010 Dec 14;182(18):E When feasible, offer choice to child (parent s lap?)

6 Non-negotiable Components of Procedural Pain Management in Children 2/4 Distraction & Integrative therapies Integrative Therapies for Needle Procedures Cochrane Review: 28 trials, 1951 children 2-19 years - needle-procedures (immunizations and injections). Uman LS, Chambers CT, McGrath PJ, Kisely SR. Psychological interventions for needlerelated procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD Effective: Distraction Hypnosis Combined cognitive-behavioral interventions Promising but limited evidence: Information/preparation Nurse coaching plus distraction Parent positioning plus distraction Distraction plus suggestion

7 Integrative Therapies for Needle Procedures To reduce pain at the time of injection among children four years of age and older, offer to rub or stroke the skin near injection site with moderate intensity before and during vaccination (grade B recommendation, based on level II-1 evidence) Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, et al. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. CMAJ : Canadian Medical Association journal 2010 Dec 14;182(18):E Integrative Therapies for Needle Procedures Children (5-10 yrs) perceive their parents as worried, when they reassure (e.g. it s okay ) - whereas distraction is associated with increased child coping McMurtry CM, Chambers CT, McGrath PJ, Asp E. When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure. Pain Jul; 150(1):52-8. Parent coaching: Certain types of parental behaviours (e.g., nonprocedural talk, suggestions on how to cope, humour) have been related to decreases in children s distress and pain, whereas others (e.g., reassurance, apologies) have been related to increases in children s distress and pain. Taddio A, Chambers CT, Halperin SA, et al. Inadequate pain management during childhood immunizations: the nerve of it. Clin Ther 2009;31(Suppl 2):S )

8 Distraction Hypnosis in Pediatric Practice: Imaginative Medicine in Action By Laurence Sugarman, MD A documentary for child health professionals Distraction Reduction of fear and anxiety Determine if the child wishes to watch or be distracted Young children: books, bubbles and pinwheels Coaching roles for parents Older children: video games and biofeedback Non-negotiable Components of Procedural Pain Management in Children 3/4 Topical Anesthesia

9 Topical Local Anesthetics " To reduce pain at the time of injection, encourage parents to use topical anesthetics during vaccination of children (grade A recommendation, based on level I evidence). Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, et al. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. CMAJ : Canadian Medical Association journal 2010 Dec 14;182(18):E " Topical anesthetics are considered safe for children of all ages. However, administration of excessive doses and/or prolonged application times can lead to serious adverse effects, including irregular heartbeat, seizures and difficulty breathing medeff/advisories-avis/public/_2009/emla ametop_pc-cp-eng.php " For children undergoing vaccination, there is insufficient evidence for or against the use of skin-cooling techniques (vapocoolants, ice, cool/cold packs) to reduce pain at the time of injection (grade I recommendation, based on conflicting level I evidence). EMLA versus LMX EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) vs Ela-Max LMX 4% Lidocaine Topical Anesthetic Cream (1) Koh JL, Harrison D, Myers R, Dembinski R, Turner H, McGraw T: A randomized, double-blind comparison study of EMLA and ELA-Max for topical anesthesia in children undergoing intravenous insertion. Paediatr Anaesth (12):977-82; (2) Eichenfield LF, Funk A, Fallon-Friedlander S, Cunningham BB: A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics (6): Ela-Max LMX: 30 minutes application as effective as 60 minutes EMLA application for preventing pain during IV insertion in Children Analgesia duration: EMLA 1-2 hours vs. LMX 1 hour Skin time: EMLA 4 hours vs. LMX 2 hours Ametop gel (4% amethocaine [tetracaine]) Cochrane Review: Although EMLA is an effective topical anaesthetic for children, amethocaine is superior in preventing pain associated with needle procedures. Lander JA, Weltman BJ, So SS. EMLA and Amethocaine for reduction of children's pain associated with needle insertion. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD EMLA and amethocaine gel comparable efficacy for procedural pain relief in children, but EMLA requires longer application time (60 vs 30 minutes) Murat I, Gall O, Tourniaire B: Procedural pain in children: evidence-based best practice and guidelines. Reg Anesth Pain Med Nov-Dec;28(6):561-72

10 EMLA and Neonates In neonates, EMLA reduces the behavioral pain response to venipuncture but not heel lance Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G: A systematic review of lidocaine-prilocaine cream (EMLA) in the treatment of acute pain in neonates. Pediatrics (2):E1 Single doses (up to x4/day) have not been associated with methemoglobinemia Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G: A systematic review of lidocaine-prilocaine cream (EMLA) in the treatment of acute pain in neonates. Pediatrics (2):E1 Effective for neonates > 34 weeks gestation for lumbar puncture Kaur G, Gupta P, Kumar A: A randomized trial of eutectic mixture of local anesthetics during lumbar puncture in newborns. Arch Pediatr Adolesc Med 2003, 157(11): EMLA -> Prilocaine -> Methemoglobinemia (case studies, inflamed skin) Premies: LMX 4% for 15 minutes 1% Buffered Lidocaine Buffered subcutaneous Lidocaine as effective as Ela- Max LMX for preventing pain during IV insertion in children Luhmann J, Hurt S, Shootman M, Kennedy R. A comparison of buffered lidocaine versus ELA-Max before peripheral intravenous catheter insertions in children. Pediatrics (3 Pt 1):e Effective use: Distraction during the needle stick Pain from a 30 gauge needle stick may be barely noticeable. Intradermal: More effective than placebo in preventing pain during IV insertion in children (1) Fein JA, Boardman CR, Stevenson S, Selbst SM: Saline with benzyl alcohol as intradermal anesthesia for intravenous line placement in children. Pediatr Emerg Care (2): (2) Klein EJ, Shugerman RP, Leigh-Taylor K, Schneider C, Portscheller D, Koepsell T: Buffered lidocaine: analgesia for intravenous line placement in children. Pediatrics (5): J-Tip (Lidocaine) J-tip: single-use, disposable, carbondioxide-powered, needleless lidocaine injector

11 LET Anesthesia 3mL LET-gel: Lidocaine 4%- Epinephrine 0.18% -Tetracaine 0.5% Singer AJ, Stark MJ. Pretreatment of lacerations with lidocaine, epinephrine, and tetracaine at triage: a randomized double-blind trial. Acad Emerg Med Jul;7(7): Sitting upright Distraction Topical Anesthesia Non-negotiable Components of Procedural Pain Management in Children 4/4 Age 0-12 months: Sucrose Sucrose for Children 0-12 months Reduces pain (PIPP, VAS) and cry during painful procedure, such as venipuncture Stevens B, Cochrane Database of Systematic Reviews 2004, Issue 3 Role of endogenous opioids - naloxone blunts effect Effective dose (24%): ml (= g) Administration 2 minutes prior to mild - moderately painful procedure Duration ~ 4 min Does not prevent development of hyperalgesia Taddio A, Shah V, Atenafu E, Katz J. Influence of repeated painful procedures and sucrose analgesia on the development of hyperalgesia in newborn infants. Pain Jul;144(1-2):43-8. Breastfeeding Effective in term infants (superior to sweetening agents) (1) Shah PS, Cochrane Database of Systematic Reviews 2006, Issue 3 (2) Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics Apr;109(4): (3) Weissman A, Aranovitch M, Blazer S, Zimmer EZ. Heel-lancing in newborns: behavioral and spectral analysis assessment of pain control methods. Pediatrics Nov;124(5):e Ineffective in preterm infants? Holsti L, Oberlander TF, Brant R. Does breastfeeding reduce acute procedural pain in preterm infants in the neonatal intensive care unit? A randomized clinical trial. Pain Nov;152(11):

12 Mother s Milk (Sucrose) for Children 0-12 months University Teaching Hospital in Lusaka, Zambia, Africa (Nov 2011) Infants Procedural Pain Classification of Procedures on NICU (from clinicians opinions) No pain (0-2): head u/s, chest x-ray, diaper change Discomfort (2-4): nasal prongs, eye exam (no manipulation), nasal/oral suction, NG tube, extubation Real pain (4-6): tracheal suction, umbilical cath, bladder cath, S/Q injection, remove CVL/art line/tcp More pain (6-7): heel stick, I/M injection, venipuncture, peripheral IV, remove chest tube Lots of pain (7-8): arterial puncture, tracheal intubation, arterial catheter, CVL catheter Unbearable pain (8-10): circumcision, lumbar puncture, chest tube placement, bone marrow biopsy K. J. S. Anand, MBBS, D.Phil., FAAP, FCCM, FRCPCH: Pain in Neonates: assessment, management, long-term effects; Feb 2007

13 Integrative Therapies for Neonates Neonates Nonpharmacologic, supportive measures: Breastfeeding (Shah PS, Cochrane Database of Systematic Reviews 2006, Issue 3) Sucrose (Stevens B, Cochrane Database of Systematic Reviews 2004, Issue 3 Nesting/Swaddling Kangaroo care (Gray, Pediatrics 2000; Johnston APAM 2003) Dimming light & noise Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, et al. Reducing the pain of childhood vaccination: an evidencebased clinical practice guideline. CMAJ : Canadian Medical Association journal 2010 Dec 14;182(18):E Premature wks: For heelstick - Kangaroo care more effective than oral glucose, which is more effective than placebo Freire NB, Garcia JB, Lamy ZC. Evaluation of analgesic effect of skin-to-skin contact compared to oral glucose in preterm neonates. Pain. 2008; 139(1): Epub 2008 Integrative Therapies for Neonates Morphine does NOT provide adequate analgesia for acute procedural pain among preterm neonates Carbajal R, Lenclen R, Jugie M, Paupe A, Barton BA, Anand KJ. Morphine does not provide adequate analgesia for acute procedural pain among preterm neonates. Pediatrics Jun;115(6): Providing natural warmth [Ohmeda-Ohio 3000 Infant Warmer System] to newborn infants during a painful procedure decreases the crying and grimacing on par with the "gold" standard treatments of sucrose or pacifier. Gray, L., C. W. Lang, et al. (2012). "Warmth is analgesic in healthy newborns." Pain 153(5): Suggested Ladder of Pain Management for Neonates 7. Deep Sedation/Analgesia or General Anesthesia 6. Local Anesthetics: SC infiltration; nerve blocks 5. Opioids (Fentanyl, Morphine) - slow infusion plus bolus Medium - Severe Pain 4. Acetaminophen (Paracetamol) PO or PR 3. Topical Anesthetic Cream 2. Sucrose, Pacifier, Kangaroo Care, Swaddling 1. Avoid Painful Procedures Mild (- Medium) Pain Anand KJS, Bergqvist L, Hall RW, Carbajai R: Acute Pain Management in Newborn Infants. International Association for the Study of Pain: Clinical Updates. Dec Vol XiX, Issue 6, pp 1-6

14 dummy (Aus.) = Pacifier (US) Non-negotiable Components of Procedural Pain Management in Children Other Considerations (5) (Intranasal) Systemic Analgesia (6) Sedation Intranasal Opioid Application Nasal mucosa richly vascularized Fenestrated epithelium drains by way of the facial and sphenopalatine veins Avoiding first pass metabolism

15 Intranasal Opioid Application Drops or spray diluted in normal saline 0.9% Pharmacokinetic profile similar to i.v. in children Mucosal Atomization Device (MAD) Intranasal Opioid Application Drops or spray diluted in normal saline 0.9% Pharmacokinetic profile similar to i.v. in children RCT 24 children (4-8 years) Burn dressing changes Control: oral morphine Titrated until pain free intranasal dose slightly higher (1.4 mcg/kg + 15mcg Q5min) pain relief comparable safety profile acceptable, no serious adverse events Borland ML, Bergesio R, Pascoe EM, Turner S, Woodger S. Intranasal fentanyl is an equivalent analgesic to oral morphine in paediatric burns patients for dressing changes: a randomised double blind crossover study. Burns Nov;31(7): Intranasal Opioid Application RCT 32 children (4-8 years) Postoperative analgesia Control: i.v. fentanyl Titrated until pain free intranasal dose slightly higher (1.4 mcg/kg) pain relief comparable safety profile acceptable, no serious adverse events Manjushree R, Lahiri A, Ghosh BR, Laha A, Handa K. Intranasal fentanyl provides adequate postoperative analgesia in pediatric patients. Can J Anaesth Feb; 49(2): Case report Acute pain ER 48 children (3-12 years) Dose applied every 5 minutes as required Median dose: 1.5 mcg/kg good pain control no side effects Borland ML, Jacobs I, Geelhoed G. Intranasal fentanyl reduces acute pain in children in the emergency department: a safety and efficacy study. Emerg Med (Fremantle) Sep;14(3):

16 Sedation If good procedural analgesia not feasible with the 4 Non-Negotiables, consider: (1) Mild sedation: Nitrous gas Zier, J. L. and M. Liu (2011). "Safety of high-concentration nitrous oxide by nasal mask for pediatric procedural sedation: experience with 7802 cases." Pediatric emergency care 27(12): or (2) Moderate/deep sedation (e.g. ketamine, propofol) Note: A sedative alone (such as a benzodiazepine) can never be a substitute for procedural analgesia. Thanks to Patricia D. Scherrer MD, Medical Director, Sedation Services Children's Hospitals and Clinics of Minnesota IV Access Under Nitrous Gas 22 months-old, LMX in place, needed IV for radiologic procedure, history of challenging IV access in the past

17 Conclusions Procedural Pain Choose your language: Would it be okay, if you are bothered less this time when we access your port-a-cath? Offering choice to child is key Make nitrous gas available Treatment protocol for painful procedures is expected standard of care in 21st century: Non-negotiable: positioning, topical anesthesia, integrative therapies, sucrose plus/minus sedation; systemic anesthesia Further Reading Zempsky WT. Optimizing the management of peripheral venous access pain in children: evidence, impact, and implementation. Pediatrics Nov;122 Suppl 3:S Zempsky WT. Pharmacologic approaches for reducing venous access pain in children. Pediatrics Nov;122 Suppl 3:S Further Training 7th Annual Pediatric Pain Master Class Minneapolis, MN June 7-13, 2014 Center to Advance Palliative Care (CAPC) - Pediatric Palliative Care Leadership Center (PCLC) Training Dec 4-6, 2013 Education in Palliative & End-of-life Care [EPEC]: Become an EPEC-Pediatrics Trainer San Diego, March 15-16, 2014 Pediatric Integrative Medicine Master Class Minneapolis, MN Sept 21-26, 2014 Stefan J. Friedrichsdorf, MD Medical Director Department of Pain Medicine, Palliative Care & Integrative Medicine Children's Hospitals and Clinics of Minnesota 2525 Chicago Ave S Minneapolis, MN USA phone fax

It s Just a Poke, Right? Procedural Pain Management in Pediatrics. Learning Objectives. Procedural Pain in Children

It s Just a Poke, Right? Procedural Pain Management in Pediatrics. Learning Objectives. Procedural Pain in Children It s Just a Poke, Right? Procedural Pain Management in Pediatrics Stefan J. Friedrichsdorf, MD, FAAP Medical Director, Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Hospitals

More information

Morphine. Small Group work, please

Morphine. Small Group work, please Considering what your child is up against, what are you hoping for? Practicing opioid prescribing by using case examples Stefan J. Friedrichsdorf, MD, FAAP Medical Director, Department of Pain Medicine,

More information

Advanced Integrative (Non- Pharmacological) Pain Management Techniques. Objectives. Integrative Medicine

Advanced Integrative (Non- Pharmacological) Pain Management Techniques. Objectives. Integrative Medicine Advanced Integrative (Non- Pharmacological) Pain Management Techniques Stefan J. Friedrichsdorf, MD, FAAP Associate Professor of Pediatrics, University of Minnesota Medical School Medical Director, Department

More information

1/6/18. Inspiration. Trauma. Pain-free Dermatology: Minimizing Discomfort in Procedures for Children and Adults. Minimizing Pain.

1/6/18. Inspiration. Trauma. Pain-free Dermatology: Minimizing Discomfort in Procedures for Children and Adults. Minimizing Pain. Pain-free Dermatology: Minimizing Discomfort in Procedures for Children and Adults I have no relevant disclosures Peter A. Lio, MD, FAAD Assistant Professor Clinical Dermatology & Pediatrics Northwestern

More information

Effect of Topical Anesthetics on Vaccine: A Focused Practice Question

Effect of Topical Anesthetics on Vaccine: A Focused Practice Question Effect of Topical Anesthetics on Vaccine: A Focused Practice Question Augustina Nagberi-Asseez, Analyst, Research and Policy Sarah Loseth, Supervisor Loretta Rowan, Manager November 2015 i Table of Contents

More information

PROVINCIAL STANDARDS & GUIDELINES

PROVINCIAL STANDARDS & GUIDELINES PROVINCIAL STANDARDS & GUIDELINES USE OF TOPICAL ANAESTHETICS TO EASE CANNULATION PAIN Created Nov 2011 Updated Oct 2015 Approved by the BCPRA Hemodialysis Committee Table of Contents 1.0 Scope...3 2.0

More information

While the target users of this CPG will likely be physicians and nurses, pain management is the responsibility of all health care professionals.

While the target users of this CPG will likely be physicians and nurses, pain management is the responsibility of all health care professionals. 1.0 Introduction The purpose of this Clinical Practice Guideline (CPG) is to optimize the assessment and management of pain in children at SickKids with the goal of limiting or preventing pain. The document

More information

Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy

Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy Awake regional versus general anesthesia in preterms and ex-preterm infants for herniotomy Department of Anaesthesia University Children s Hospital Zurich Switzerland Epidemiology Herniotomy needed in

More information

(1996) 2002 JAMA. IDM

(1996) 2002 JAMA. IDM Neonatal Sedation Joseph Cravero MD First Question Does Pain/Stress Control Matter? Especially in very young patients. Really? Responses to Pain - Newborns learn quickly Taddio et. al. 2002 JAMA. IDM s

More information

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE Surgical Care at the District Hospital 1 14 Practical Anesthesia Key Points 2 14.1 General Anesthesia Have a clear plan before starting anesthesia Never use an unfamiliar anesthetic technique in an emergency

More information

Using Pediatric Pain Scales

Using Pediatric Pain Scales Using Pediatric Pain Scales We care about your child s comfort. You are an important member of your child s healthcare team. You know your child best. We want to partner with you to help control your child

More information

THE EFFICACY OF ORAL GLUCOSE FOR RELIEVING PAIN FOLLOWING INTRAMUSCULAR INJECTION IN TERM NEONATES

THE EFFICACY OF ORAL GLUCOSE FOR RELIEVING PAIN FOLLOWING INTRAMUSCULAR INJECTION IN TERM NEONATES THE EFFICACY OF ORAL GLUCOSE FOR RELIEVING PAIN FOLLOWING INTRAMUSCULAR INJECTION IN TERM NEONATES F. Sajedi 1*, Z. Kashaninia, M. Rahgozar 3 and L. Radrazm 4 1) Department of Clinical Sciences, University

More information

CHILDREN S SERVICES. Trust Medicines Policy and Procedures Paediatric Pain Assessment Chart

CHILDREN S SERVICES. Trust Medicines Policy and Procedures Paediatric Pain Assessment Chart CHILDREN S SERVICES POLICY AND PROCEDURE FOR THE ADMINISTRATION OF INTRANASAL DIAMORPHINE VIA SYRINGE OR ATOMIZER FOR PAEDIATRIC ANALGESIA IN PAEDIATRIC A&E See also: Trust Medicines Policy and Procedures

More information

Nosocomial Injection:

Nosocomial Injection: 2013 EMS STATE OF THE SCIENCE: Gathering of Eagles XVI Nosocomial Injection: Intranasal Midazolam for Pediatric Seizures Dr. David P. Keseg M.D. FACEP Associate Professor Ohio State University Wexner Medical

More information

New Medicines Profile

New Medicines Profile New Medicines Profile August 2008 Issue. 08/07 Lidocaine 70mg/tetracaine 70mg medicated plaster (Rapydan ) Concise evaluated information to support the managed entry of new medicines in the NHS Summary

More information

Disclosures. Regional Anesthesia Update Objectives. Do Peripheral Nerve Blocks Last Long Enough? Peripheral Nerve Catheter

Disclosures. Regional Anesthesia Update Objectives. Do Peripheral Nerve Blocks Last Long Enough? Peripheral Nerve Catheter Disclosures Regional Anesthesia Update 2014 I have no commercial conflicts of interest Christopher Ciarallo MD FAAP Assistant Professor of Anesthesiology The University of Colorado SOM Objectives 1. Discuss

More information

POST-INTUBATION ANALGESIA AND SEDATION. August 2012 J Pelletier

POST-INTUBATION ANALGESIA AND SEDATION. August 2012 J Pelletier POST-INTUBATION ANALGESIA AND SEDATION August 2012 J Pelletier Intubated patients experience pain and anxiety Mechanical ventilation, endotracheal tube Blood draws, positioning, suctioning Surgical procedures,

More information

The Game Plan. Should I Be Doing This? The Perfect Drug. Procedural Sedation

The Game Plan. Should I Be Doing This? The Perfect Drug. Procedural Sedation Procedural Sedation Sanjay Arora MD Associate Professor of Emergency Medicine Keck School of Medicine at USC Los Angeles County + USC Medical Center May 23, 2012 The Game Plan Who shouldn t get sedation

More information

Sedation in Children

Sedation in Children CHILDREN S SERVICES Sedation in Children See text for full explanation and drug doses Patient for Sedation Appropriate staffing Resuscitation equipment available Monitoring equipment Patient suitability

More information

Topical Local Anaesthesia

Topical Local Anaesthesia Topical Local Anaesthesia Comfort Kids Program 2017 Topical Local Anaesthesia (LA) How does topical LA cream works Misconceptions Cautions Preparation Application Alternatives Dosage Documentation Basic

More information

DELIRIUM IN ICU: Prevention and Management. Milind Baldi

DELIRIUM IN ICU: Prevention and Management. Milind Baldi DELIRIUM IN ICU: Prevention and Management Milind Baldi Contents Introduction Risk factors Assessment Prevention Management Introduction Delirium is a syndrome characterized by acute cerebral dysfunction

More information

Pain Relief During Labor and Delivery

Pain Relief During Labor and Delivery Pain Relief During Labor and Delivery Each woman's labor is unique. The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size

More information

Original Paper. Neonatology 2017;112: DOI: /

Original Paper. Neonatology 2017;112: DOI: / Original Paper Received: November 11, 2016 Accepted after revision: February 20, 2017 Published online: May 31, 2017 Randomized Controlled Trial Comparing Different Single Doses of Intravenous Paracetamol

More information

Management of Pain in Children. The Royal College of Emergency Medicine. Best Practice Guideline

Management of Pain in Children. The Royal College of Emergency Medicine. Best Practice Guideline The Royal College of Emergency Medicine Best Practice Guideline Management of Pain in Children Revised Management of pain in children (REV July 2017) 1 July 2017 Summary of recommendations 1. Recognition

More information

Simulation 3: Post-term Baby in Labor and Delivery

Simulation 3: Post-term Baby in Labor and Delivery Simulation 3: Post-term Baby in Labor and Delivery Opening Scenario (Links to Section 1) You are an evening-shift respiratory therapist in a large hospital with a level III neonatal unit. You are paged

More information

Learning Objectives. Describe how interdisciplinary collaboration can impact individualized care and help reduce pain and anxiety.

Learning Objectives. Describe how interdisciplinary collaboration can impact individualized care and help reduce pain and anxiety. How Phlebotomist Training, Experience and Use of Comfort Techniques Impacts Pediatric Patient Experience and Clinical Practice 2017 Annual Conference San Diego, CA Michigan Medicine Pathology & Office

More information

Interventions for paediatric procedure-related pain in primary care

Interventions for paediatric procedure-related pain in primary care ORIGINAL ARTICLE Interventions for paediatric procedure-related pain in primary care Jill E MacLaren PhD 1, Lindsey L Cohen PhD 2 JE MacLaren, LL Cohen. Interventions for paediatric procedure-related pain

More information

Guidance on competencies for Paediatric Pain Medicine reviewed 2017

Guidance on competencies for Paediatric Pain Medicine reviewed 2017 Guidance on competencies for Paediatric Pain Medicine reviewed 2017 Endorsed by: Contents Introduction A: Core competencies for practitioners in Pain Medicine Page 2 4 Appendix A: Curriculum 5 B: Competencies

More information

MORPHINE ADMINISTRATION

MORPHINE ADMINISTRATION Introduction Individualised Administration Drug of Choice Route of Administration & Doses Monitoring of Neonates & high risk patients Team Management Responsibility Morphine Protocol Flow Chart Introduction

More information

Research The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial

Research The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial CMAJ JAMC Research The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial Ken J. Farion MD, Karen L. Splinter MD, Kym Newhook BScN RN, Isabelle

More information

META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY

META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY RESIDENT RESEARCH EXCHANGE DAY MAY 30 TH, 2014 SUPERVISOR: DR. JAMES PAUL SUSAN JO PGY4 SUZANNE LAMBERT PGY4 ADA HINDLE PGY4 INTRODUCTION

More information

The Management of Pain in Children (and Adults)

The Management of Pain in Children (and Adults) The Management of Pain in Children (and Adults) Myron Yaster, MD Richard J Traystman Professor, Departments of Anesthesiology, Critical Care Medicine, and Pediatrics The Johns Hopkins Medical Institutions

More information

ANESTHESIA. Planning Your Childbirth: Pain Relief During Labor and Delivery EACH WOMAN S LABOR IS

ANESTHESIA. Planning Your Childbirth: Pain Relief During Labor and Delivery EACH WOMAN S LABOR IS ANESTHESIA & YOU Planning Your Childbirth: Pain Relief During Labor and Delivery EACH WOMAN S LABOR IS UNIQUE T he amount of pain a woman feels during labor may differ from that felt by another woman.

More information

UCSF PAIN SUMMIT /8/15

UCSF PAIN SUMMIT /8/15 UCSF PAIN SUMMIT 2015 5/8/15 Case 3 Geriatric Pain Disclosure Statements UCSF PAIN SUMMIT 2015 Wendy Anderson Patrice Villars 5/8/15 Case 3 Geriatric Pain Pain Management in the Geriatric & End-of-Life

More information

The use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study

The use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study Kasr El Aini Journal of Surgery VOL., 10, NO 3 September 2009 97 The use of Pudendal Nerve Block in Hemorrhoidectomy Operations: A Prospective Double Blind Placebo Control Study Sherif Adly and Mohamed

More information

Reducing Pain In Four- To Six-Month Old Infants Undergoing Immunization Using A Multi-Modal Approach

Reducing Pain In Four- To Six-Month Old Infants Undergoing Immunization Using A Multi-Modal Approach Reducing Pain In Four- To Six-Month Old Infants Undergoing Immunization Using A Multi-Modal Approach by Mary-Ellen Hogan A thesis submitted in conformity with the requirements for the degree of Master

More information

Anesthesia Safety. What is anesthesia and how does it work? Local anesthesia

Anesthesia Safety. What is anesthesia and how does it work? Local anesthesia Scan for mobile link. Anesthesia Safety What is anesthesia and how does it work? Anesthesia is a state of consciousness or sedation achieved by using medications and/or non-pharmacologic adjuncts (therapy

More information

Inspiration. Trauma. Minimizing Pain 7/17/16

Inspiration. Trauma. Minimizing Pain 7/17/16 Pain-free Dermatology: Minimizing Discomfort in Procedures for Children and Adults Peter A. Lio, MD, FAAD Assistant Professor Clinical Dermatology & Pediatrics Northwestern University Feinberg School of

More information

Two-Minute Skin Anesthesia Through Ultrasound Pretreatment and Iontophoretic Delivery of a Topical Anesthetic: A Feasibility Study

Two-Minute Skin Anesthesia Through Ultrasound Pretreatment and Iontophoretic Delivery of a Topical Anesthetic: A Feasibility Study Blackwell Publishing IncMalden, USAPMEPain Medicine1526-23752007 Blackwell Publishing Ltd? 2007915559Original Article Two-Minute Topical AnesthesiaSpierings et al. PAIN MEDICINE Volume 9 Number 1 2008

More information

Interventional Radiology Skills Checklist

Interventional Radiology Skills Checklist Interventional Radiology Skills Checklist This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your

More information

Unfortunately, pain is a natural and unavoidable part

Unfortunately, pain is a natural and unavoidable part January-April, 2013/Vol 33/Issue 1 doi: http://dx.doi.org/10.3126/jnps.v33i1.7017 Original Ar icle Effect of Distraction Technique During Immunization to Reduce Behaviour Response Score (FLACC) to Pain

More information

STARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION

STARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION STARSHIP WITHDRAWAL OF ANALGESIA AND SEDATION Patients receiving analgesia and/or sedation for longer than 5-7 days may suffer withdrawal if these drugs are suddenly stopped. To prevent this happening

More information

Sonoma Valley Hospital Sonoma Valley Healthcare District Policy and Procedure Organizational. Page: 1

Sonoma Valley Hospital Sonoma Valley Healthcare District Policy and Procedure Organizational. Page: 1 Title: PAIN MANAGEMENT Sonoma Valley Hospital Organizational Number: PC-104 Page: 1 Effective Date: 3/96 Mary Kelly, R.N., M.P.A. 12/07 Approved By Date Revision Dates: 07/01, 02/02 Signature on file Signature

More information

Proceedings of the Workshop. Conquering Pain: The Hidden Cost of Immunization

Proceedings of the Workshop. Conquering Pain: The Hidden Cost of Immunization Proceedings of the Workshop Conquering Pain: The Hidden Cost of Immunization January 28, 2008 University of Toronto, Toronto, Canada Primary Responsible Author: Anna Taddio BScPhm, MSc, PhD, Associate

More information

Opioid Pearls and Acute Pain Management

Opioid Pearls and Acute Pain Management Opioid Pearls and Acute Pain Management Jeanie Youngwerth, MD University of Colorado Denver Assistant Professor of Medicine, Hospitalist Associate Director, Colorado Palliative Medicine Fellowship Program

More information

PICU BRONCHIOLITIS PLAN

PICU BRONCHIOLITIS PLAN PICU BRONCHIOLITIS PLAN Diagnosis Weight PHYSICIAN S Allergies Admit/Discharge/Transfer Patient Status Pt Status: Inpatient (LOS > 2 midnights) Pt Status: Observation (LOS < 2 midnights) Patient Care Code

More information

Lumbar Transversus Abdominis Plane (TAP) Block: Does volume make a difference?

Lumbar Transversus Abdominis Plane (TAP) Block: Does volume make a difference? Lumbar Transversus Abdominis Plane (TAP) Block: Does volume make a difference? Dr. Mauricio Forero, Assistant Professor, McMaster University, St. Joseph`s Healthcare, Hamilton, Ontario. Dr. Andrew Heikkila,

More information

Pain in the Pediatric Palliative Care Context

Pain in the Pediatric Palliative Care Context Pain in the Pediatric Palliative Care Context Erin Shepherd, RN, MN; CNS WRHA Pediatric Symptom Management and Palliative Care Service David Lambert, MD, FRCPC; Director Pediatric Acute Pain Service, Physician

More information

ANAESTHESIA EDY SUWARSO

ANAESTHESIA EDY SUWARSO ANAESTHESIA EDY SUWARSO GENERAL REGIONAL LOCAL ANAESTHESIA WHAT DOES ANESTHESIA MEAN? The word anaesthesia is derived from the Greek: meaning insensible or without feeling. The adjective will be ANAESTHETIC.

More information

1/21/14. Cancer Related Pain: Case-Based Pharmacology. Conflicts of Interest. Learning Objective

1/21/14. Cancer Related Pain: Case-Based Pharmacology. Conflicts of Interest. Learning Objective Cancer Related Pain: Case-Based Pharmacology Jeannine M. Brant, PhD, APRN, AOCN Oncology Clinical Nurse Specialist Nurse Scientist Billings Clinic Conflicts of Interest Jeannine Brant has served on the

More information

MD (Anaesthesiology) Title (Plan of Thesis) (Session )

MD (Anaesthesiology) Title (Plan of Thesis) (Session ) S.No. 1. To study the occurrence of postoperative hyponatremia in paediatric patients under 2 years of age 2. Influence of timing of intravenous fluid therapy on maternal hemodynamics in patients undergoing

More information

Anesthesia: Analgesia: Loss of bodily SENSATION with or without loss of consciousness. Absence of the sense of PAIN without loss of consciousness

Anesthesia: Analgesia: Loss of bodily SENSATION with or without loss of consciousness. Absence of the sense of PAIN without loss of consciousness 1 2 Anesthesia: Loss of bodily SENSATION with or without loss of consciousness Analgesia: Absence of the sense of PAIN without loss of consciousness 3 1772: Joseph Priestly discovered Nitrous Oxide NO

More information

Intranasal (IN) Medication Administration MBED Clinical Practice Guideline

Intranasal (IN) Medication Administration MBED Clinical Practice Guideline Intranasal (IN) Medication Administration MBED Clinical Practice Guideline Purpose and Indications: Intranasal administration of medications can be used to achieve rapid sedation/anxiolysis, pain control,

More information

Management of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017

Management of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Management of Acute Pain in the Chronic Pain Patient Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Objectives 1. Describe the unique challenges of managing acute pain episodes in patients being

More information

Vascular malformations and their management

Vascular malformations and their management Information for patients Vascular malformations and their management Introduction This leaflet tells you about the condition known as vascular malformation, including venous malformation, arteriovenous

More information

Neurobiology of Acute Pain in Early Life

Neurobiology of Acute Pain in Early Life Neurobiology of Acute Pain in Early Life K. J. S. Anand, MBBS, D.Phil., FAAP, FCCM, FRCPCH Morris & Hettie Oakley Endowed Chair of Critical Care Medicine Professor of Pediatrics, Anesthesiology, Pharmacology

More information

Early Goal Directed Sedation In Critically Ill Patients

Early Goal Directed Sedation In Critically Ill Patients Early Goal Directed Sedation In Critically Ill Patients Yahya Shehabi, FCICM, FANZCA, EMBA Professor, Intensive Care Medicine Clinical School of Medicine, University New South Wales School of Epidemiology

More information

REVIEW ARTICLE. Sedation and Analgesia for Pediatric Fracture Reduction in the Emergency Department. one of the most common injuries

REVIEW ARTICLE. Sedation and Analgesia for Pediatric Fracture Reduction in the Emergency Department. one of the most common injuries REVIEW ARTICLE Sedation and Analgesia for Pediatric Fracture Reduction in the Emergency Department A Systematic Review Russell T. Migita, MD; Eileen J. Klein, MD, MPH; Michelle M. Garrison, MPH Objective:

More information

2008 EAGLES PRESENTATION. Intranasal Versed Usage in an Urban Fire Based EMS System: PARAMEDIC PERCEPTION OF UTILITY

2008 EAGLES PRESENTATION. Intranasal Versed Usage in an Urban Fire Based EMS System: PARAMEDIC PERCEPTION OF UTILITY 2008 EAGLES PRESENTATION Intranasal Versed Usage in an Urban Fire Based EMS System: PARAMEDIC PERCEPTION OF UTILITY CFD EMS OVERVIEW CFD EMS OVERVIEW CFD EMS OVERVIEW All ALS EMS System Two EMT-Ps on each

More information

Part 1 Principles and Routes of Medication Administration

Part 1 Principles and Routes of Medication Administration 1 Chapter 7, Medication Administration Part 1 Principles and Routes of Medication Administration 2 Caution: Administering medications is business Always take appropriate Standard measures to reduce your

More information

Addendum D. Procedural Sedation Test MERCY MEDICAL CENTER- SIOUX CITY. Procedural Sedation Questions

Addendum D. Procedural Sedation Test MERCY MEDICAL CENTER- SIOUX CITY. Procedural Sedation Questions Addendum D. Procedural Sedation Test MERCY MEDICAL CENTER- SIOUX CITY Procedural Sedation Questions Individuals applying for moderate sedation privileges must achieve a score of 80%. PRACTITIONER NAME

More information

ENA: EMERGENCY NURSING ORIENTATION

ENA: EMERGENCY NURSING ORIENTATION ENA: EMERGENCY NURSING ORIENTATION Lesson Notebook: Pain Lesson Outline Key Resources Preceptor Exercise LESSON OUTLINE Definitions and Classification of Pain Pain is whatever the person experiencing it

More information

BLOOD COLLECTION GUIDELINES

BLOOD COLLECTION GUIDELINES I. Patient Identification Lee Memorial Health System Lee County, FL CLINICAL LABORATORY BLOOD COLLECTION GUIDELINES A. Inpatient / Outpatient with armband 1. When possible, ask patient to state their name

More information

UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis

UMC Health System Patient Label Here. PHYSICIAN ORDERS Diagnosis Diagnosis Weight Allergies Patient Care Vital Signs Per Unit Standards q12h q12h, Temperature Only - Every Shift and PRN Patient Activity Assist as Needed, Bed Position: As Tolerated, elevate to patient

More information

Efficacy of the Valsalva Maneuver on Needle Projection Pain and Hemodynamic Responses During Spinal Puncture

Efficacy of the Valsalva Maneuver on Needle Projection Pain and Hemodynamic Responses During Spinal Puncture 156 Research Paper International Journal of Medical Sciences 2011; 8(2):156-160 Ivyspring International Publisher. All rights reserved. Efficacy of the Valsalva Maneuver on Needle Projection Pain and Hemodynamic

More information

Palliative Care Pearls: What Works, What Doesn t

Palliative Care Pearls: What Works, What Doesn t : Steven Pantilat, MD Kates-Burnard and Hellman Distinguished Professor of Palliative Care Director, Palliative Care Program and Palliative Care Quality Network Department of Medicine University of California,

More information

Effective Postoperative Pain Management for Children. Nancy L. Glass, MD, MBA,

Effective Postoperative Pain Management for Children. Nancy L. Glass, MD, MBA, Effective Postoperative Pain Management for Children Nancy L. Glass, MD, MBA, FAAP nglass@bcm.edu @DrNancyGlass1 None Disclosures Learning Objectives At the end of this presentation, participants will

More information

Learning Objectives. Case Example. From Coke to Pepsi or a cocktail? Rotating and adding opioids in advanced pediatric pain medicine

Learning Objectives. Case Example. From Coke to Pepsi or a cocktail? Rotating and adding opioids in advanced pediatric pain medicine From Coke to Pepsi or a cocktail? Rotating and adding opioids in advanced pediatric pain medicine Stefan J. Friedrichsdorf, MD, FAAP Associate Professor of Pediatrics, University of Minnesota Medical School

More information

INDIANA HEALTH COVERAGE PROGRAMS

INDIANA HEALTH COVERAGE PROGRAMS INDIANA HEALTH COVERAGE PROGRAMS PROVIDER CODE TABLES Note: Due to possible changes in Indiana Health Coverage Programs (IHCP) policy or national coding updates, inclusion of a code on the code tables

More information

Catheter-directed Thrombolysis

Catheter-directed Thrombolysis Scan for mobile link. Catheter-directed Thrombolysis Catheter-directed thrombolysis treats vascular blockages and improves blood flow by dissolving abnormal blood clots. A blood clot, or thrombus, can

More information

Objectives: What is your Definition of Pain? 8/16/2017

Objectives: What is your Definition of Pain? 8/16/2017 Safe Opioid Management for the Seriously Ill Patient Sam Perna, D.O. Objectives: MDB1 1) Participants will understand the way the body s pain system works. 2) Participants will identify the elements of

More information

Research questions: What is the clinical and cost-effectiveness of PCA to manage pain in a hospital setting?

Research questions: What is the clinical and cost-effectiveness of PCA to manage pain in a hospital setting? Title: Patient Controlled Analgesia for Pain Management Date: May 9, 2007 Context and policy issues: Pain following surgery is often treated inadequately, with about 75% of patients experiencing moderate

More information

Chapter 64 Administration of Injectable Medications

Chapter 64 Administration of Injectable Medications Chapter 64 Administration of Injectable Medications Injectable Medications Injection or intravenous (IV) infusion More invasive than administration by mouth, rectum, or through the skin Common methods

More information

Care in the Last Days of Life

Care in the Last Days of Life Care in the Last Days of Life Introduction This guideline is an aid to clinical decision making and good practice in person-centred care for patients who are deteriorating and at risk of dying. The patient

More information

Pediatric Patients. BCFPD Paramedic Education Program. EMS Education Paramedic Level

Pediatric Patients. BCFPD Paramedic Education Program. EMS Education Paramedic Level Pediatric Patients BCFPD Program Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Allow

More information

The following criteria must be met in order to obtain pediatric clinical privileges for pediatric sedation.

The following criteria must be met in order to obtain pediatric clinical privileges for pediatric sedation. Pediatric Sedation Sedation of children is different from sedation of adults. Sedatives are generally administered to gain the cooperation of the child. The ability of the child to cooperate depends on

More information

Objectives. What is pain? 9/27/2017. Pain: Does this Hurt? Fall 2017 Dean Fox, MD, FACP

Objectives. What is pain? 9/27/2017. Pain: Does this Hurt? Fall 2017 Dean Fox, MD, FACP Pain: Does this Hurt? Fall 2017 Dean Fox, MD, FACP Photo credit: http://multiple-sclerosis-research.blogspot.com/2013/10/pain-and-unemployment.html Objectives Consider personal goal of pain management

More information

Minimum effective dose of midazolam for sedation of mechanically ventilated neonates

Minimum effective dose of midazolam for sedation of mechanically ventilated neonates Journal of Clinical Pharmacy and Therapeutics (2005) 30, 479 485 ORIGINAL ARTICLE Minimum effective dose of midazolam for sedation of mechanically ventilated neonates J.-M. Treluyer* MD PhD, S.Zohar PhD,

More information

Post-Dural Puncture Headache. Dr. Jacobs Aurélie Krans Anesthesie 18/03/2016 Kliniek St.-Jan, Brussel

Post-Dural Puncture Headache. Dr. Jacobs Aurélie Krans Anesthesie 18/03/2016 Kliniek St.-Jan, Brussel Post-Dural Puncture Headache Dr. Jacobs Aurélie Krans Anesthesie 18/03/2016 Kliniek St.-Jan, Brussel I - PATHOPHYSIOLOGY August Bier (intrathecal cocaïn1898)! first 2 cases PDPH CSF leak trough dura mater

More information

Comparison of EMLA to LMX-4 for Sharp Wound Debridement. July 27, 2017 Wendy Woith, PhD, RN, FAAN

Comparison of EMLA to LMX-4 for Sharp Wound Debridement. July 27, 2017 Wendy Woith, PhD, RN, FAAN Comparison of EMLA to LMX-4 for Sharp Wound Debridement July 27, 2017 Wendy Woith, PhD, RN, FAAN Conflict of Interest Statement The authors have no conflicts of interest to report Wendy Woith, Ph.D., RN,

More information

Pain in Pediatric Oncology: Do the Experiences of Children and Parents Differ from Those of Nurses and Physicians?

Pain in Pediatric Oncology: Do the Experiences of Children and Parents Differ from Those of Nurses and Physicians? Upsala Journal of Medical Sciences ISSN: 0300-9734 (Print) 2000-1967 (Online) Journal homepage: http://www.tandfonline.com/loi/iups20 Pain in Pediatric Oncology: Do the Experiences of Children and Parents

More information

Product Catalog. Pediatric Learning Solutions. Listing of all current products (as of May, 2013) offered by Children's Hospital Association.

Product Catalog. Pediatric Learning Solutions. Listing of all current products (as of May, 2013) offered by Children's Hospital Association. Product Catalog Pediatric Learning Solutions Listing of all current products (as of May, 2013) offered by Children's Hospital Association. Acquired Heart Disease in Children WBT Acute Respiratory Distress

More information

New Modalities for Treating. Perioperative Pediatric Pain OPIOID-ASSOCIATED SIDE EFFECTS

New Modalities for Treating. Perioperative Pediatric Pain OPIOID-ASSOCIATED SIDE EFFECTS New Modalities for Treating Perioperative Pediatric Pain R. Scott Dingeman, MD, FAAP Associate Clinical Professor, UCSF Department of Anesthesia & Perioperative Care Co-Director, Integrated Pediatric Pain

More information

Phlebotomy Safety for All Ages

Phlebotomy Safety for All Ages Phlebotomy Safety for All Ages Safety Measures for Phlebotomy Patient Identification Preparing Equipment and Supplies Preparing Patient Post Phlebotomy Care Safety tips for specific age groups Safety for

More information

Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial

Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial Pediatric Anesthesia 2009 19: 262 266 doi:10.1111/j.1460-9592.2008.02903.x Clowns for the prevention of preoperative anxiety in children: a randomized controlled trial G. GOLAN PhD*, P. TIGHE MD, N. DOBIJA

More information

PRACTICE GUIDELINES WOMEN S HEALTH PROGRAM

PRACTICE GUIDELINES WOMEN S HEALTH PROGRAM C Title: NEWBORN: HYPOGLYCEMIA IN NEONATES BORN AT 35+0 WEEKS GESTATION AND GREATER: DIAGNOSIS AND MANAGEMENT IN THE FIRST 72 HOURS Authorization Section Head, Neonatology, Program Director, Women s Health

More information

Vaxcel Implantable Ports Valved and Non-Valved. A Patient s Guide

Vaxcel Implantable Ports Valved and Non-Valved. A Patient s Guide Vaxcel Implantable Ports Valved and Non-Valved A Patient s Guide Vaxcel Implantable Port This pamphlet provides some answers to questions you may have about your implantable port and how to care for it

More information

Supportive Care. End of Life Phase

Supportive Care. End of Life Phase Supportive Care End of Life Phase Guidelines for Health Care Professionals In the care of patients with established renal failure who are in the last days of life References: Chambers E J (2004) End of

More information

The bell is gently and slowly removed (the foreskin may naturally form an adhesion to

The bell is gently and slowly removed (the foreskin may naturally form an adhesion to Circumcision Definition: The removal of the foreskin anatomy of the penis; to cut off the clitoris and sometimes the labia of a female. This document only covers male circumcision. Male Anatomy: The foreskin,

More information

Intranasal Fentanyl in the Palliative Care of Newborns and Infants

Intranasal Fentanyl in the Palliative Care of Newborns and Infants Vol. 46 No. 2 August 2013 Journal of Pain and Symptom Management 265 Brief Report Intranasal Fentanyl in the Palliative Care of Newborns and Infants Michael S. Harlos, MD, CCFP, FCFP, Simone Stenekes,

More information

(ADULT) Refer to policy MC.E.48 for neonatal to pediatric pain assessment and management.

(ADULT) Refer to policy MC.E.48 for neonatal to pediatric pain assessment and management. Department: Policy/Procedure: PATIENT CARE PAIN ASSESSMENT AND DOCUMENTATION (ADULT) Refer to policy MC.E.48 for neonatal to pediatric pain assessment and management. Definition: Pain can be described

More information

EQUIPMENT: Nitrous Oxygen Delivery System:

EQUIPMENT: Nitrous Oxygen Delivery System: Policy: Nitrous Oxide Use in the Intrapartum and Immediate Postpartum Period for Obstetrical Patients in the Family Birth Place Approvers: CEO. CNO, Medical Staff President, Anesthesia Chair, OB Medical

More information

Children s of Alabama. Birmingham, Alabama

Children s of Alabama. Birmingham, Alabama Preoperative Evaluation of Pediatric Patients Heather Rankin, CRNA, MSN Children s of Alabama Birmingham, Alabama Objectives Define NPO guidelines Review history assessment Review system assessment Review

More information

Superior vena cava stent

Superior vena cava stent Radiology department Superior vena cava stent Introduction This leaflet tells you about the procedure known as superior vena cava (SVC) stent insertion. It explains what is involved and what the benefits

More information