Publication Date: August 2019 (Volume 16, Number 8)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 8/01/2022.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME and 4 Pain Management CME credits, subject to your state and institutional approval.
Adequate analgesia is critical in the management of pediatric patients in the emergency department. Suboptimal treatment of pain can have deleterious effects in the short term, and it can also affect a patient’s development and reaction to future painful experiences. Tools exist to quantify a patient’s pain level regardless of age or developmental stage. Both pharmacologic and nonpharmacologic methods can be effective in the management of pediatric pain. Emergency clinicians must remain vigilant in the recognition, treatment, and reassessment of pediatric pain, as patients’ developmental level may limit their ability to independently express their pain experience without prompting or tools. This issue reviews pain scales that are suitable for pediatric patients and discusses pediatric pain management using nonpharmacologic methods, topical, local, and regional anesthesia as well as systemic agents.
Excerpt From This Issue
An 8-year-old boy presents to the ED after falling at a local playground. His mother, who was with him at the time of the injury, states that he was climbing out of a tree when he slipped and fell. He landed on his outstretched hands and is now complaining of right wrist pain. On examination, he has no open wounds, and he has a normal neurovascular examination, but he has an obvious deformity of his right forearm. The child describes his pain as 7/10. You ponder how best to treat the child’s severe pain as quickly as possible...
Your next patient is a 7-year-old boy who is brought in for 1 day of fever and right lower quadrant abdominal pain. His examination is significant for rebound and guarding of his right lower quadrant. The boy rates his pain as 9/10. You order initial laboratory studies. The patient’s mother pulls you aside to tell you that her son has had bad experiences with IV placement in the past, and she is very concerned about the associated pain. Meanwhile, one of the nurses tells to you that the on-call surgery resident will come to see your patient with possible acute appendicitis, but she will be delayed. The surgeon requested that you defer pain medication until her return to the ED, since pain medication will “ruin” her examination. You consider what to do next…