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Key Resources

Bottom Line Recommendations: Procedural Pain (2022)

Bottom Line Recommendations: Procedural Pain (2022)

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Drs. Samina Ali, Amy Drendel, Corrie Chumpitazi, Naveen Poonai

Drs. Samina Ali, Amy Drendel, Corrie Chumpitazi, Naveen Poonai

Evidence Repository: Procedural pain

Evidence Repository: Procedural pain

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Drs. Samina Ali, Amy Drendel, Corrie Chumpitazi, Naveen Poonai

Drs. Samina Ali, Amy Drendel, Corrie Chumpitazi, Naveen Poonai

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.
Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).
More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/ 

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.
Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).
More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/ 

UNDER REVIEW: Bottom Line Recommendations: Procedural Sedation  (2018)

UNDER REVIEW: Bottom Line Recommendations: Procedural Sedation

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Evered L, Bhatt M & TREKK Network

Evered L, Bhatt M & TREKK Network

Bottom line recommendations for pediatric procedural sedation. Published online: March 2018.

Bottom line recommendations for pediatric procedural sedation. Published online: March 2018.

Procedural Sedation: Evidence Repository (2022)

Procedural Sedation: Evidence Repository (2022)

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Dr. Maala Bhatt and Dr. Corrie Chumpitazi

Dr. Maala Bhatt and Dr. Corrie Chumpitazi

For a list of references that were used in the creation of this resource, see Evidence Repository: Procedural Sedation (2022)

For a list of references that were used in the creation of this resource, see Evidence Repository: Procedural Sedation (2022)

Evidence Repository: Pain Treatment (2022)  (2022)

Evidence Repository: Pain Treatment (2022)

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For a list of references that were used in the creation of this resource, see Evidence Repository: Pain Treatment (2022)

For a list of references that were used in the creation of this resource, see Evidence Repository: Pain Treatment (2022)

Bottom Line Recommendations: Pain Treatment (2022)

Bottom Line Recommendations: Pain Treatment (2022)

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Dr. Samina Ali, Dr. Corrie Chumpitazi, Dr. Amy Drendel, & Dr. Naveen Poonai

Dr. Samina Ali, Dr. Corrie Chumpitazi, Dr. Amy Drendel, & Dr. Naveen Poonai

Recommandations de base: Douleur procédurale (2022)

Recommandations de base: Douleur procédurale (2022)

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Samina Ali, Amy Drendel, Corrie Chumpitazi, Naveen Poonai

Samina Ali, Amy Drendel, Corrie Chumpitazi, Naveen Poonai

Bottom line recommendations for the treatment and management of procedural pain - French. Version 3.0 published online December 8, 2022.

Bottom line recommendations for the treatment and management of procedural pain - French. Version 3.0 published online December 8, 2022.

Systematic reviews

Cochrane Systematic Review: Non-pharmacological management of infant and young child procedural pain

Cochrane Systematic Review: Non-pharmacological management of infant and young child procedural pain

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Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Gerwitz-Stern A

Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, A...

OBJECTIVES: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

OBJECTIVES: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Cochrane Systematic Review: Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age

Cochrane Systematic Review: Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age

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Kassab M, Foster JP, Foureur M, Fowler C

Kassab M, Foster JP, Foureur M, Fowler C

OBJECTIVES: To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods.

OBJECTIVES: To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods.

Systematic Review: Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?  (2018)

Systematic Review: Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

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Tseng, PT, Leu, TH, Chen, YW and Chen, YP

Tseng, PT, Leu, TH, Chen, YW and Chen, YP

The aim of this study was to compare HB and PSA for adult and pediatric patients during reduction of displaced distal radius fracture to identify the level of pain relief, frequency of adverse effects (AEs), and reduction failure.

The aim of this study was to compare HB and PSA for adult and pediatric patients during reduction of displaced distal radius fracture to identify the level of pain relief, frequency of adverse effects (AEs), and reduction failure.

Cochrane Systematic Review: Adjusting the pH of lidocaine for reducing pain on injection

Cochrane Systematic Review: Adjusting the pH of lidocaine for reducing pain on injection

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Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R

Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R

OBJECTIVES: The objective of this review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children. We tested the hypothesis that adjusting the pH of lidocaine solution to a level closer to the physiologic pH reduces this pain.

OBJECTIVES: The objective of this review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children. We tested the hypothesis that adjusting the pH of lidocaine solution to a level closer to the physiologic pH reduces this pain.

Cochrane Systematic Review: Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

Cochrane Systematic Review: Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

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Andreae MH, Andreae DA

Andreae MH, Andreae DA

OBJECTIVES: To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery.

OBJECTIVES: To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery.

Cochrane Systematic Review: Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain

Cochrane Systematic Review: Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain

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Almeida MO, Silva BN, Andriolo RB, Atallah AN, Peccin MS

Almeida MO, Silva BN, Andriolo RB, Atallah AN, Peccin MS

OBJECTIVES: To assess the effects (benefits and harms) of conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain.

OBJECTIVES: To assess the effects (benefits and harms) of conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain.

Cochrane Systematic Review: Pharmacotherapy for patellofemoral pain syndrome

Cochrane Systematic Review: Pharmacotherapy for patellofemoral pain syndrome

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Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW

Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW

OBJECTIVES: This review aims to summarise the evidence of effectiveness of pharmacotherapy in reducing anterior knee pain and improving knee function in people with PFPS.

OBJECTIVES: This review aims to summarise the evidence of effectiveness of pharmacotherapy in reducing anterior knee pain and improving knee function in people with PFPS.

Cochrane Systematic Review: Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

Cochrane Systematic Review: Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

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Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE

Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE

OBJECTIVES: To determine the effectiveness of medication for recurrent abdominal pain in school-age children.

OBJECTIVES: To determine the effectiveness of medication for recurrent abdominal pain in school-age children.

Cochrane Systematic Review: Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents

Cochrane Systematic Review: Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents

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Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G

Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G

OBJECTIVES: The primary objectives were to conduct a systematic review to evaluate the efficacy and safety of antidepressants for the treatment of abdominal pain-related FGIDs in children and adolescents.

OBJECTIVES: The primary objectives were to conduct a systematic review to evaluate the efficacy and safety of antidepressants for the treatment of abdominal pain-related FGIDs in children and adolescents.

Cochrane Systematic Review: Oxcarbazepine for neuropathic pain

Cochrane Systematic Review: Oxcarbazepine for neuropathic pain

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Zhou M, Chen N, He L, Yang M, Zhu C, Wu F

Zhou M, Chen N, He L, Yang M, Zhu C, Wu F

OBJECTIVES: To determine the benefits and harms of oxcarbazepine for different forms of neuropathic pain.

OBJECTIVES: To determine the benefits and harms of oxcarbazepine for different forms of neuropathic pain.

Cochrane Systematic Review: EMLA and Amethocaine for reduction of children's pain associated with needle insertion

Cochrane Systematic Review: EMLA and Amethocaine for reduction of children's pain associated with needle insertion

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Lander JA, Weltman BJ, So SS

Lander JA, Weltman BJ, So SS

OBJECTIVES: To compare the topical anaesthetics amethocaine and an eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy, ease of needle insertion and adverse events when used for intravenous cannulation and venipuncture in children.

OBJECTIVES: To compare the topical anaesthetics amethocaine and an eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy, ease of needle insertion and adverse events when used for intravenous cannulation and venipuncture in children.

Cochrane Systematic Review: Hydromorphone for acute and chronic pain

Cochrane Systematic Review: Hydromorphone for acute and chronic pain

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Quigley C

Quigley C

OBJECTIVES: This review explores and assesses the evidence for the efficacy of hydromorphone in the management of pain.

OBJECTIVES: This review explores and assesses the evidence for the efficacy of hydromorphone in the management of pain.

Cochrane Systematic Review: Local anaesthetic sympathetic blockade for complex regional pain syndrome

Cochrane Systematic Review: Local anaesthetic sympathetic blockade for complex regional pain syndrome

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Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE

Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE

OBJECTIVES: To assess the efficacy of LASB for the treatment of pain in CRPS and to evaluate the incidence of adverse effects of the procedure.

OBJECTIVES: To assess the efficacy of LASB for the treatment of pain in CRPS and to evaluate the incidence of adverse effects of the procedure.

Cochrane Systematic Review: NSAIDS or paracetamol, alone or combined with opioids, for cancer pain

Cochrane Systematic Review: NSAIDS or paracetamol, alone or combined with opioids, for cancer pain

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McNicol E, Strassels SA, Goudas L, Lau J, Carr DB

McNicol E, Strassels SA, Goudas L, Lau J, Carr DB

OBJECTIVES: To assess the effects of NSAIDs, alone or combined with opioids, for the treatment of cancer pain.

OBJECTIVES: To assess the effects of NSAIDs, alone or combined with opioids, for the treatment of cancer pain.

Cochrane Systematic Review: Oral morphine for cancer pain

Cochrane Systematic Review: Oral morphine for cancer pain

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Wiffen PJ, Wee B, Moore RA

Wiffen PJ, Wee B, Moore RA

OBJECTIVES: To determine the efficacy of oral morphine in relieving cancer pain, and assess the incidence and severity of adverse effects.

OBJECTIVES: To determine the efficacy of oral morphine in relieving cancer pain, and assess the incidence and severity of adverse effects.

Cochrane Systematic Review: Pharmacologic interventions for treating phantom limb pain

Cochrane Systematic Review: Pharmacologic interventions for treating phantom limb pain

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Alviar MJ, Hale T, Dungca M

Alviar MJ, Hale T, Dungca M

OBJECTIVES: This review aims to summarize the evidence of effectiveness of pharmacologic interventions in treating PLP.

OBJECTIVES: This review aims to summarize the evidence of effectiveness of pharmacologic interventions in treating PLP.

Cochrane Systematic Review: Diclofenac for acute pain in children  (2009)

Cochrane Systematic Review: Diclofenac for acute pain in children

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Standing JF, Savage I, Pritchard D, Waddington M

Standing JF, Savage I, Pritchard D, Waddington M

OBJECTIVES: 1) Assess the efficacy of diclofenac for acute pain in children. 2) Assess the safety of diclofenac for short-term use in children. 3) Identify gaps in the evidence to direct future research.

OBJECTIVES: 1) Assess the efficacy of diclofenac for acute pain in children. 2) Assess the safety of diclofenac for short-term use in children. 3) Identify gaps in the evidence to direct future research.

Key studies

Key Study: Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures  (2017)

Key Study: Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures

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Morrison T, Carender C, Kilbane B, Liu RW

Morrison T, Carender C, Kilbane B, Liu RW

The current study was conducted to answer 2 questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation : 1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? 2) Is there a difference in the rates of major sedation-related complications?

The current study was conducted to answer 2 questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation : 1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? 2) Is there a difference in the rates of major sedation-related complications?

Key Study: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?  (2017)

Key Study: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?

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Hirsch, D G, Tyo, J and Wrotniak, B H

Hirsch, D G, Tyo, J and Wrotniak, B H

The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.

The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.

Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department  (2018)

Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department

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Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, Berg, A M, Longjohn, M and Kink, R J

Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...

The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.

The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.

Key Study: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway  (2015)

Key Study: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway

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Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M

Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M

This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

Other

Emergency Medicine Cases Podcast: Pediatric abdominal pain & appendicitis  (2010)

Emergency Medicine Cases Podcast: Pediatric abdominal pain & appendicitis

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Dr. Anna Jarvis & Dr. Stephen Freedman

Dr. Anna Jarvis & Dr. Stephen Freedman

Episode 19 Part 1:In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis & Dr. Stephen Freedman discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows. Published online: December 2011.  

Episode 19 Part 1:In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis & Dr. Stephen Freedman discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows. Published online: December 2011.  

Emergency Medicine Cases Podcast: Pediatric Pain Management  (2015)

Emergency Medicine Cases Podcast: Pediatric Pain Management

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Dr. Samina Ali & Dr. Anthony Crocco

Dr. Samina Ali & Dr. Anthony Crocco

Episode 67: Pain is the most common reason for seeking health care. It accounts for 80% of ED visits. The WHO has declared that “optimal pain treatment is a human right”. As has been shown in multiple ED-based Pediatric pain management studies, Pediatric pain is all too often under-estimated and under-treated. Why does this matter? Under-estimating and under-treating pediatric pain may have not only short term detrimental effects but life-long detrimental effects as well; not to mention, screaming miserable children disturbing other patients in your ED and complaints to the hospital from parents. Whether it’s venipuncture, laceration repair, belly pain or reduction of a fracture we need to have the skills and knowledge to optimize efficient and effective pain management in all the kids we see in the ED. What are the indications for intranasal fentanyl? intranasal ketamine? Why should codeine be contra-indicated in children? How do triage-initaited pain protocols improve pediatric pain management? Which are most effective skin analgesics for venipuncture? To help you make these important pediatric pain management decisions, in this podcast we have one of the most prominent North American researchers and experts in Emergency Pediatric pain management, Dr. Samina Ali and not only the chief of McMaster Children’s ED but also the head of the division of Pediatric EM at McMaster University, Dr. Anthony Crocco.

Episode 67: Pain is the most common reason for seeking health care. It accounts for 80% of ED visits. The WHO has declared that “optimal pain treatment is a human right”. As has been shown in multiple ED-based Pediatric pain management studies, Pediatric pain is all too often under-estimated and under-treated. Why does this matter? Under-estimating and under-treating pediatric pain may have not only short term detrimental effects but life-long detrimental effects as well; not to mention, screaming miserable children disturbing other patients in your ED and complaints to the hospital from parents. Whether it’s venipuncture, laceration repair, belly pain or reduction of a fracture we need to have the skills and knowledge to optimize efficient and effective pain management in all the kids we see in the ED. What are the indications for intranasal fentanyl? intranasal ketamine? Why should codeine be contra-indicated in children? How do triage-initaited pain protocols improve pediatric pain management? Which are most effective skin analgesics for venipuncture? To help you make these important pediatric pain management decisions, in this podcast we have one of the most prominent North American researchers and experts in Emergency Pediatric pain management, Dr. Samina Ali and not only the chief of McMaster Children’s ED but also the head of the division of Pediatric EM at McMaster University, Dr. Anthony Crocco.

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Podcast: Pediatric Procedural Sedation

Posted: Feb 09, 2016  | Announcement  | Team: News and Events 
Tags: Procedural Sedation, Procedural Pain


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Canadian Paediatric Society Position Statement: Pain Management

Posted: Nov 05, 2019  | Announcement  | Team: News and Events 


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New Bottom Line Recommendation: Procedural Pain

Posted: Nov 07, 2016  | Announcement  | Team: News and Events 


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New resources available on trekk.ca!

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News Story: Guidelines for managing child pain in the ED

Posted: Jul 15, 2016  | Announcement  | Team: News and Events 


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New Bottom Line Recommendation: Pain Treatment

Posted: Jul 16, 2018  | Announcement  | Team: News and Events 


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