Thanks to everyone that attended the July 17 Florida EMSC Advisory Committee Meeting and stopped by the Clincon PEDReady Booth! We had a great turnout.
Encourage others to sign up for the PEDReady listserve & weekly newsbrief, the PE
2
ARL, by sharing this link:
http://bit.ly/flpearl
|
|
|
Focus | Non-Pharmacologic Pain Management
|
|
1. Non-Pharmacologic Pain Management Recipes: Distraction, VR and More
|
|
In recent PE
2
ARLs, we discussed pain scales and pharmacologic options such as IV/IN opioids or ketamine. We'll be working off of the same case scenario for this week's focus.
|
|
 |
EMS Scenario:
You arrive at the home of a 2-year-old who pulled hot water and noodles out of the microwave (name your mechanism: coffee, pot of boiling water, etc.). She has significant burns to her chest, abdomen and shoulders. Your rough estimate is 15% partial thickness burns. She is running away from you and screaming in pain. Mother is crying and asking if you will report her to DCF. Child is 1-800-BAD-OUCH. FLACC=8.
ED Scenario:
EMS arrives with a screaming 2-year-old who pulled hot water and noodles out of the microwave on to her chest, abdomen and legs. She has 15% partial thickness burns. No IV access. 1-800-BAD-OUCH!
What management techniques could you use to manage this child and her family while attempting an IV and completing her assessment?
|
|
|
|
Non-Pharmacologic Pain Management Basics:
The opioid epidemic has led to a renewed emphasis on the use of opioid alternatives to treat pain, such as nonpharmacologic techniques.
Nonpharmacologic pain management techniques (alone or as adjuncts):
- Engage the patient, caregiver and family
- Decrease use and/or dose of opioids and other pain medications
- Decrease procedure time, length of stay and adverse events
Think of nonpharmacologic management as painting your “base coat” or “primer” before applying additional coats of pharmacologic analgesic treatment (
PEM Playbook
).
When determining the most effective nonpharmacologic interventions, consider the patient’s age, developmental level, medical history, prior pain experiences, current degree of pain and/or anticipated pain association with a surgery, procedure, injury or illness.
There are Joint Commission Standards for EDs/hospitals regarding nonpharmacologic options. Learn more about them below:
|
|
Non-Pharmacologic Pain Management Recipe Ingredients:
There are two main categories: Cognitive-Behavioral and Physical/Sensory:
|
|
DISTRACTION
is the most common type of cognitive-behavioral intervention.
- Pain is reduced up to 25% through distraction alone.
- Distraction does not require advanced training for providers, works with children and adults and involves parents, families and caregivers during stressful times.
- Researchers hypothesize that children cannot attend to more than one significant stimulus at a time.
- Conversation is a great form of distraction to use in the EMS and ED settings. Topics include pets, hobbies, vacation, sports, etc. Learn more about this technique here.
There is science behind distraction—it's not all rainbows and butterflies!
|
|
K.A. Birnie et al. Mechanisms of distraction in acute pain perception and modulation. Pain Journal 2017;158(6):1012-1013
The ABC's of Distraction:
A – Assorted visuals
B – Breathing techniques
C – Comfort Positions
D – Diversional Talk
- Give a choice only when choices exist
- Limit number of voices
E – Encouragement and praise
- Be specific: “You’re doing a good job at taking deep breaths” instead of “Good boy”
- Click here for sample language
|
|
Distraction and Nonpharmacologic Tools:
|
|
Keep a box or bag of distraction tools in your ambulance or ED.
Click here
for more information and email
pedready@jax.ufl.edu
if you need distraction starter supplies!
- Beware of infection control and small parts.
- Make sure the distraction technique or item is age and developmentally appropriate.
|
|
|
Virtual Reality (VR):
- VR engages the patient in a 360° visual and auditory experience, which removes the primary focus from pain and/or anxiety.
- VR has been studied for burn and wound care, infusion centers, procedures, labor and delivery and other settings.
- Click here to learn more and see a list of suggested VR apps by age
More Resources:
|
|
2. PEDReady Champions of the Week
|
|
Thanks to UF Jacksonville EM Research Coordinators and University of North Florida Summer EM Research Interns for rapidly assembling 20 new PEDReady Toolbags! Florida EDs and EMS agencies can contact
pedready@jax.ufl.edu
for their free bag.
|
|
3. Upcoming Pediatric Emergency Conferences
|
|
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.
|
|
|
Caring for Critical Kids Conference
August 22-23, 2019 | Gainesville, FL
Hosted by: UF Health ShandsCair
Join UF Health ShandsCair to learn more about caring for children with critical medical and trauma needs. Thursday is lecture day; Friday is skills lab day.
|
|
|
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
|
|
|
|
|
|
|
|
