Pain management + resuscitation Flashcards
pain behaviours in children?
- favouring one arm or leg over the other
- decrease in physical activity
- changes in appetite or sleep pattern
- avoiding contact with other children
- physical cues: dull eyes, flushed skin, rapid breathing or sweating
What is pain?
- personal experience that is influenced by biological,
psychological and social factors - throughout their life experiences individuals learn concept
of pain - pain may have adverse effects on function and social and
psychological welbeing
What is acute pain
- complex near physical phenomenon which is affected by sensory, physiological & psychosocial
- two types of pain
- Nociceptive - injury to tissue other than nerves
- Neuropathic - damage to either peripheral or central nerves
What are the harmful effects of unrelieved pain?
Systems:
- Cardiovascular: Increase HR, BO, CO, 02 consumption - Respiratory: increase RR, Decrease flow/vol Sa02 - Endocrine: Increase cortisol, adrenaline, glucagon, BSL - Gastrointestinal: decrease gastric & gut motility - Musculoskeletal: tension, spasm, fatigue
What are the consequences of unmanaged pain both physical and psychological?
Physical:
• Rapid shallow breathing
• Inadequate expansion of lungs and poor cough
• Increase HR, BP and O2 requirements
• Endocrine: Increase cortisol, adrenaline, glucagon, BSL
• Slow healing and impaired immune function
• Slowing of the gut
• Reluctance to mobilise further delaying recovery
Psychological
• Fear of hospital
• Behavioural changes/development regression
• Less co-operative with future procedures
• Sleep disturbances
• Reduced coping (anxiety, depression, withdrawn)
• Effect on parents/carers
Assessing for pain:
3 main approaches in children
- self reporting - observation of behaviours - observation of physiological signs
What are some assessment tools used for pain in infants?
- FLACC
- NIPS
What are the aims of pain management?
- safety
- appropriate medications and dosing
- monitoring side effects
- educating patients and parents
- support and optimise recovery
- deep breathing/ chest physiological
- movement in bed
- mobilisation as appropriate
- managing expectations and anxieties
What are the procedural pain relief for children?
- topical anaesthetics
- sucrose
- breast feeding
- nitrous oxide
- intra-nasal
- buccal
- non-pharmacological management
What is the action of opioids in children?
- act on opioid receptors in the brain and the spinal cord
- receptors can become less responsive to opioid with use over time: TOLERANCE
- Centrally acting
- euphoria & analgesia
- CNS side effects
What are the side effects of opioids?
- serious
- sedation
- respiratory depression/ apnoea
- Common
- pruitis
- N & V
- Constipation
- Urinary retention
- Less common
- myoclonic jerks
- opioid induced hyperalgesia
- dependence
Principles of opioid use?
- NO1 IS PATIENT SAFETY
- monitoring: vitals, side effects, effective analgesia
- Reversal available & prescribed - Naloxone
- Education of patient/ carer
- Keeping infusions rate low, optimising boluses PRN
Responding to a sick child?
- distinct developmental, anatomical and physiological characteristics increase susceptibility to respiratory to respiratory and circulatory compromise
- Assessment of ABCD involves obtaining and evaluating key assessment data
- early warning tools BTF, PEWS, CERS to escalate as required
- deteriorating child may require airway, breathing and circulatory support
Respiratory support in basic life support?
- should be early intervention
- nasal prongs
- use appropriate size mask
- if sats drop apply paediatric Hudson masks with minimum flow rate of 4L/min
Circulatory support in basic life support?
- IV access is important before problems occur
- if child is deteriorating and IV not possible the intraosseous (IO) route may be used to gain emergency vascular access
- fluids should always be delivered via a pump not gravity flow
