Are you guys pretty comfortable with treating pain in infants? I had an 11 month old last night with approx 10% BSA 1st degree and approx 2% 2nd degree burns - from scalding. Infant was in obvious distress but mom wasn't comfortable with her child getting MS. Kid was 11kg - I was going to give our starting dose of 0.1mg/kg IM - 1.1mg IM. By the time I was getting mom to understand we were at the hospital. Doctor ended up giving the same MS dose. Thoughts on analgesia in those too young or old to express their pain verbally? Or speaking to parents/caregivers?
Physicians' Impression of Pre-Hospital Pain Management
- Thread starter redcrossemt
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Smash
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I really hope that I have just misunderstood your post, and that you haven't just referred to migraine as a "petty problem"
DV_EMT
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Yeah... I was referring to other minor dumb injuries as "petty" not the migranes. Subject-verb agreement error on my part
I think you're right to want to pain control this child. It's a shame the mother wouldn't agree. I wasn't there, but it doesn't sound like it's your fault she refused.
I don't know how your system is set up, or if there was any suspicion that this was an act of abuse or that the child might have other more serious injuries. I would prefer to start an IV, or give IM pain medication prior to transport, then give additional pain medication en route. Based on the information provided, I wouldn't consider this a time-critical trauma patient.
Did the mother explain why she didn't want pain control? It seems like a strange decision.
In my system a call for a child that young with a c/c of trauma, burns, hemorrhage, traumatic injury, etc - generates a PD response. They examined the scene and interviewed mother after I left. Physical assessment didn't reveal any other signs of trauma or neglect - old or new. Child was well nourished, living quarters were adequate, and she seemed consolable by mom. I documented it as I saw as how it allegedly occurred. We have the channels available to report child abuse - in this case I chose not to. Mother seemed worried about analgesia due to side effects and a slight language barrier. Transport time was 5 minutes and by the time she understood we were at the ED.
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I always get frustrated with parents who are reluctant to allow providers to administer pain meds to their child. I know they are typically genuinely concerned, but if this mother had scalding burns to 10% of her body, I garauntee she would want some pain meds.
I am extremely comfortable giving pain meds to kids, mostly because that's my area of expertise, but also because pain management is just as important in these patient as it is in adults.
I have had parents be reluctant to allow pain meds for their child before, but as a provider, it is my duty to provide relevant education on the issue, and project the confidence necessary to gain the parents trust. If I can't give them a valid reason other than "it's good for your kid" and I appear uncomfortable, of course the parent isnt going to trust me.
If I can explain to the parents how important it is to keep their child comfortable and minimize pain in order to allow me to best assess and care for them.
Most of the time because I work peds critical care, parents have total trust. If they don't, we have to quickly earn that trust in order to get the parents on the same page with us, and facilitate family centered care.
Parents can be educated about the benefit of a procedure and generally get over the mental obstacle they have of not wanting the procedure due to it causing discomfort to the child, or any concern they have about complications. The goal should be to take any and all emotion out of informed consent. Your interactions and attitude have everything to do with how the parents will deal with the stress of the situation.
I am extremely comfortable giving pain meds to kids, mostly because that's my area of expertise, but also because pain management is just as important in these patient as it is in adults.
I have had parents be reluctant to allow pain meds for their child before, but as a provider, it is my duty to provide relevant education on the issue, and project the confidence necessary to gain the parents trust. If I can't give them a valid reason other than "it's good for your kid" and I appear uncomfortable, of course the parent isnt going to trust me.
If I can explain to the parents how important it is to keep their child comfortable and minimize pain in order to allow me to best assess and care for them.
Most of the time because I work peds critical care, parents have total trust. If they don't, we have to quickly earn that trust in order to get the parents on the same page with us, and facilitate family centered care.
Parents can be educated about the benefit of a procedure and generally get over the mental obstacle they have of not wanting the procedure due to it causing discomfort to the child, or any concern they have about complications. The goal should be to take any and all emotion out of informed consent. Your interactions and attitude have everything to do with how the parents will deal with the stress of the situation.
Smash
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Phew!
Pain relief in kids and elderly can be problematic, mostly because of communication issues, but sometimes because of attitudes or beliefs of care-givers, and sometimes unfortunately providers. I've worked with people who refuse to cannulate children, unless they are in arrest, which is bizarre and more cruel than actually placing a line and giving pain relief.
Intranasal fentanyl can be quite effective in children where you don't want to, or can't start a line. I'm also fascinated by fentanyl lollipops, but I'm picking I won't get them on the truck any time soon - so much potential for abuse!
I always try to apply a common sense approach to my care and to explaining stuff to parents - does that look like it would hurt? It gets pain relief! Does that look like it would hurt you? Then let your kid have pain relief!
Nervegas
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Could always have one the the glass ampules crack weird and spray fentanyl everywhere, including the medics eye who tried to open it, ocular administration anyone?
While a migraine isn't a petty problem by any means (I get them myself), we are discovering in medicine that opiates for headaches without skull fractures or ICH are one of the worst things we can do. Patients bounce back and end up needing large doses of narcotics. Most physicians in my area refuse to give narcotics for migraines.
DV_EMT
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Seems like anti imflamatories would be a better route?
Smash
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Indeed, which is why we give prochlorperasine, metoclopramide, lidocaine, steroids depending on the situation. Which of course does not detract from the need for pain relief, but rather highlights the lack of options that most systems have for managing pain.