PEM Pearls

Painful procedures in the ED

Painful procedures in the emergency department are often a source of anxiety for children, parents and even emergency medicine practitioners. 

We all want to do our best to minimize distress in children presenting to the ED.  For example in the case of venepuncture, a range of pharmacological techniques are often implemented, including EMLA cream, intranasal fentanyl and midazolam in very distressed children.
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However, there is evidence to show that distraction techniques alone or in conjunction with other medical interventions can be effective in reducing perception of pain and distress in paediatric patients (Oliveira et al 2017).
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Some of the things that work best from my experience

• Favourite cartoon either on TV in the patients room or on a smart phone 
• Headphones and music 
• Singing a song to the patient – even if all you can remember is baby shark! 
• Clown therapy. If there are clown doctors in your hospital they are invaluable. 
• Soft toys, especially helpful shield child’s vision from the painful procedure. I often find if they can’t see what’s happening they don’t realise it’s happening especially with venepuncture
• Sensory light up toys for children to look at, especially good for eye exams. Here is a great example.

Suggestion for regional/ smaller mixed ED

• Designated portable DVD player to play movies with head phones for children getting longer procedures such as suturing. 

 
References:
Oliveira, N., Santos, J. and Linhares, M. (2017), Audiovisual distraction for pain relief in paediatric inpatients: A crossover study. Eur J Pain, 21: 178-187. https://doi.org/10.1002/ejp.915

Dr Jacqueline Mills