Paediatric analgesia and sedation in the emergency department

Loftie-Eaton, V G

Paediatric analgesia and sedation in the emergency department

Thesis / Dissertation

2005

Abstract

I started my career as medical practitioner in 1979, and have since worked in many different Emergency Departments in South Africa, Namibia and the United Kingdom. In most Emergency Departments, medical personnel find it difficult to deal effectively and appropriately with pain and anxiety in the ill and injured child This perennial problem has been the motivation behind my study. I wanted to find out what the nature of the problem was, how pain and anxiety can be recognised and measured, and what methods, pharmacological and non- pharmacological, are available to deal with pain and anxiety, especially in children, in the Emergency Department I specifically investigated certain methods that are completely acceptable to patients, and that have the potential for effective, expedient and well tolerated (needle-free) analgesia and sedation. During 2004, I worked for 5 months as a locum consultant in the Accident and Emergency Department of the Royal Lancaster Infirmary in Lancaster, United Kingdom. This Department has done intensive research in the use of intramuscular ketamine for procedural sedation under the leadership of Mr (Dr) RG McGlone. This is an ongoing clinical trial in which I have also actively participated: I have used the method on many occasions, and collected data for clinical research, as described in this dissertation. I also assisted middle grade doctors in the Department by teaching them the technique. At the Royal Lancaster Infirmary Accident and Emergency Department, it is standard protocol to use intranasal diamorphine by method of a mucosa/ atomized device (MAD) in all children suffering from severe pain after injury or illness, and also using the same device for intranasal midazolam in children with persistent seizure activity. Apart from my own involvement and research into these effective methods of treatment, I have done a formal review study on the use of intramuscular ketamine for procedural sedation, and the intranasal administering of drugs such as midazolam and diamorphine in children, by using a mucosa/ atomized device (MAD). Information was obtained from official publications and medical records.

Keywords

Emergency Medicine

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