Peds Pain Mangament

Assessment and Management of Pain in Medical/Healthcare

Page 3: 5TH VITAL SIGN

  • Vital signs can indicate a physiological problem
  • Always look at baseline and trends
  • Difficulty identifying pain in pediatric patients
  • Consider factors such as gender, culture, language

Page 4: PAIN ASSESSMENT

  • Are they in pain if playing, sleeping, easily distracted?
  • Do infants feel pain?
  • How do we assess pain in different ages?

Page 5: SIGNS OF PAIN

  • Pulling on ears, rolling side to side, banging head, refusing to move
  • Flushing of skin, vital sign changes
  • Fear, anxiety, sadness
  • Behavior changes such as irritability and crying

Page 6: ASSESSMENT APPROACH

  • How to Assess Pain
    • Use of scales
    • Assessment of vital signs
  • Concerns
    • Increased risk of respiratory depression with opioids

Page 7: PAIN SCALES

  • FLACC
  • FACES
  • NRS
  • Poker Chip Tool
  • PIPP
  • Oucher

Page 8 & 9: FLACC

  • FACE, LEGS, ACTIVITY, CRY, CONSOLABILITY
  • Each category scored 0-2
  • Total score of 0-10
  • Higher the score, the higher the pain
  • Non-verbal patients
  • Infants to 7 y/o

Page 10: FACES

  • Allow the child to choose
  • Ages 3 y/o – 9 y/o
  • Consider cognitive ability

Page 11: NRS

  • No Pain as bad pain as it could be
  • Mild Moderate Severe
  • No Pain as bad pain as it could be
  • 0 1 2 3 4 5 6 7 8 9 10
  • 9 y/o
  • Consider cognitive ability

Page 13: MANAGING PAIN: ACUTELY

  • Mild to Moderate: Non-opioids, Tylenol & NSAIDS
  • Mod to Severe: Opioid of choice: Morphine
  • NO Demerol: CNS Stimulation
  • Inadequate pain control management

Page 14: MANAGING PAIN: ACUTELY PCA/NCA WITH OPIOID

  • NCA vs PCA
  • Can begin use of PCA in 5-6yo
  • Small frequent doses = better relief w/out sedation
  • Side/Adverse Effects
  • Monitor VS, pain, signs of respiratory depression, anaphylaxis
  • Gives some control to child

Page 15: MANAGING PAIN: ACUTELY CONSCIOUS SEDATION

  • Depressed LOC
  • Protective reflexes intact, may verbally respond
  • Side/Adverse effects
  • Ketamine, Fentanyl, Versed, Propofol

Page 16: MANAGING PAIN: MISCELLANEOUS THERAPIES

  • EMLA/ LMX solutions often used for topical numbing in 37 wk gestation +
  • Works in 30 minutes
  • Lidocaine Sprays: rapid onset
  • Sucrose

Page 17: MANAGING PAIN: ALTERNATIVE THERAPIES

  • Distraction
  • Preparation
  • Relaxation
  • Room Temp
  • TENS (transcutaneous electrical nerve stimulation)
  • Massage
  • Acupuncture

Page 18: MANAGING PAIN: AT HOME

  • Distraction
  • Controlled Breaths
  • Massage
  • Repositioning
  • Medications
  • Warm/Cold Compress