Happy 4th of July!
Next Thursday is July 4, 2019 and we will not be sending a PEARL. We wish everyone a safe holiday!

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June 27, 2019
Focus | Pediatric Pain Scales
1. Pain Scales
SCENARIO: You are faced with a screaming 2-year-old child who just sustained scald burns to her chest and chin. She pulled a pot of boiling water and pasta off of a stove top .

What pain scale should you use in your assessment?
  • Wong Baker FACES Scale
  • Numerical Rating Scale
  • FLACC or r-FLACC Scale
  • Defense and Veterans Pain Rating Scale (DVPRS)
  • Oucher Scale

Find out below!
Did You Know?

  • There are almost 100 different pain scales, but very few have been validated in EMS or pediatric ED settings.
  • Your initial management of acute pediatric pain in the field and ED sets the trajectory and tone for future pain experiences as an adolescent and adult!
  • Uncontrolled acute pain may lead to long-term sequelae such as post-traumatic stress symptoms and chronic pain.
Creation of Pain Memory in Children
Background:

Pain is a common pediatric presentation in EMS and ED settings, and we often have to do something painful to treat the child. Examples include:
  • Trauma
  • Burns
  • IV placement or drawing blood for labs
  • Abscess or cellulitis
  • Foreign body
  • And many more

Pain can cause physiologic (↑HR, BP and myocardial oxygen consumption) and psychologic effects in children.

Children might not disclose pain or downplay the level of pain for many reasons:
  • Avoidance of painful procedures
  • Fear of healthcare professionals
  • Protection of parents or caregiver
  • Avoidance of hospitalization
  • Desire to return to activities
  • Sports
  • Social events
  • School
Pediatric Pain Scale Pearls:

Pain scales fall into two general categories:
  • Observational-behavioral scales
  • Self-report scales

Your choice of pain scale will depend on the following:
  • Age
  • Verbal or nonverbal
  • Cognitive level
  • GCS or orientation
  • Agency or institution policy
  • Setting

The Joint Commission has pain assessment standards that were revised in 2018. Read them here .
  • EDs: be sure you know the standards and your hospital policies for pain scales and assessments

Be consistent when using pain scales. Once a pain scale is chosen, try to use that same scale throughout the patient’s treatment journey
  • Prehospital to ED to hospital 
Examples of Pain Scales
Pain Scale: Infant & Older (Nonverbal Children)
Nonverbal, GCS <15 or Cognitive Impairment
Most EMS agencies and EDs use FLACC for infants and children <3 years of age.
Pain Scale: 3 Years & Older
Faces Type Scales: Verbal, Alert & Oriented
For faces type scales, be sure the child is selecting how they feel now versus how they want to feel.
Pain Scale: 8 Years & Older
Verbal Numeric Scale (VNS)/Numeric Rating Scale (NRS)
A 2018 study supported the use of the Verbal Numerical Rating Scale for most children aged 6 years and older, but not for those aged 4-5 years. Remember—not all children follow the textbooks!
Resources:
 
  • Pain Scales Recommended in the 2014 EBG for Prehospital Analgesia in Trauma by Gausche-Hill et. al
  • From 2009-2013, a stakeholder group used the National Prehospital Evidence-Based Guideline (EBG) model process to develop a guideline for prehospital pain management in trauma patients. The guideline includes using an age-appropriate pain scale to assess traumatic pain as follows:

SCENARIO ANSWER: The FLACC Scale

2. Upcoming Pediatric Emergency Conferences
Kid Care Trauma Conference
July 9, 2019 | Jacksonville, FL
Hosted by: UF Health Jacksonville

Approved for 8 nursing hours and 7 EMS hours
CLINCON 2019
July 17–19, 2019 | Orlando, FL
Hosted by: EMLRC

Designed for the entire spectrum of emergency care providers. General conference lectures include The Pregnant Patient Skills Lab, Tips & Tricks for Blue & Barely Breathing Baby and more! Access Brochure

Pre-Con Workshop: Managing Pediatric Cardiac Arrest
July 17, 2019 | 8:00-12:00 pm
Symposium by the Sea 2019
August 1-4, 2019 | Boca Raton, FL
Hosted by: Florida College of Emergency Physicians (FCEP)

FCEP's annual meeting & educational conference, Symposium by the Sea, is designed for emergency physicians, residents, students, physician assistants, nurses and allied health professionals interested in emergency care.

Pediatric Trauma Workshop
August 2, 2019 | 9:00 am to 12:00 pm
Pediatric Care After Resuscitation (PCAR) Course
Dec 2-3, 2019 | Jacksonville, FL

The mission of TCAR (Trauma Care After Resuscitation) Education Programs is to expand the knowledge base and clinical reasoning skills of nurses who work with injured patients anywhere along the trauma continuum of care, particularly in the post-resuscitation phase. 
Thanks for being a Pediatric Champion!
The Florida PEDReady Program
pedready@jax.ufl.edu | 904-244-8617