Clinical Policy: Critical Issues in the Sedation of Pediatric Patients in the Emergency Department

Mace, Sharon E.; Brown, Lance; Francis, Lisa; Godwin, Steven A.; Hahn, Sigrid A.; Howard, Patricia Kunz; Kennedy, Robert M.; Mooney, David P.; Sacchetti, Alfred; Wears, Robert L.; Clark, R. Lee

doi:10.1016/j.annemergmed.2007.11.001

Cited by 79 publications

(37 citation statements)

References 181 publications

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“…Current guidelines from the American Academy of Pediatrics, American Society of Anesthesiologists, and American College of Emergency Physicians recommend a structured evaluation of children that allows risk stratification before beginning sedation, thereby reducing the risk of complications in the pediatric age group. 223,[227][228][229][230][231][232][233][234][235] This evaluation should include issues such as preexisting medical conditions, focused airway examination, and consideration of nil per os (NPO) status. NPO guidelines for children receiving sedation in the ED are controversial.…”

Section: Sedation Policies and Protocols In The Edmentioning

confidence: 99%

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

Zempsky¹,

Cravero²,

Shaw³

et al. 2012

Pediatrics

287

179

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Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child' s and family' s reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction. Pediatrics 2012;130:e1391-e1405 BACKGROUND A systematic approach to pain management is required to ensure relief of pain and anxiety for children who enter into the emergency medical system, which includes all emergency medical services (EMS) agencies, interfacility critical care transport teams, and the emergency department (ED). 1 The administration of appropriate analgesia in children varies by age as well as by training of the ED team (which includes physicians, nurses, physician assistants, and nurse practitioners), however, and still lags behind analgesia provided for adults in similar situations. 2 Furthermore, neonates are at highest risk of receiving inadequate analgesia. 3,4 Encouragingly, improvements in the recognition and treatment of pain in children have led to changes in the approach to pain management for acutely ill and injured pediatric patients. 5 Studies have shown an increase in opiate use in children with fractures. [6][7][8] Recent advances in the approach and support for pediatric analgesia and sedation, as well as new products and devices, have improved the overall climate of the ED for patients and families in search of the "ouchless" ED. 5,9 Increased parental education regarding pain and sedation, physician comfort and desire to enhance patient satisfaction, and a quest to satisfy accreditation regulations have appropriately driven this effort. System-wide approaches for pain management awareness and strategies work best if they are woven into the fabric of the emergency medical system through education and protocol development. The purpose of this report was to provide information to optimize the comfort and minimize the distress of children and families as they are cared for in the emergency setting.

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Section: Sedation Policies and Protocols In The Edmentioning

confidence: 99%

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

Zempsky¹,

Cravero²,

Shaw³

et al. 2012

Pediatrics

287

179

View full text Add to dashboard Cite

show abstract

“…These include clinical aspects of trauma [12,13], injury severity and acuity measures [14,15], patient outcomes [6,[16][17][18], costs [19], system organization [20], education and training [9,[21][22][23]. The PATRN team has research and clinical experience in all of these areas and is prepared to address research issues in each of these areas.…”

Section: Network Organizationmentioning

confidence: 99%

Pediatric applied trauma research network: a call to action

Upperman

Burd

Cox³

et al. 2010

Journal of Pediatric Surgery

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“…Biophysiologic instruments used to acquire cues were the glasgow coma scale, electrocardiograms, pulse oxymeter, urine collection, blood pressure auscultation, and venous and arterial blood interpreting machines (Stewar-Amidei 2009; AhA 2010). other important cues acquired are her pupilary reactions, urine outputs, and bowel sounds (Mace et al 2008;AhA 2000) to support the cues investigated through biophysiologic instrumentations.…”

Section: Information Processing Theorymentioning

confidence: 99%

“…furthermore, research shows that most middleincome and low-income countries practise this system by omitting certain kinds of medical care that are used to sustain a patient's life (kobusingye et al 2005). This is the most common form of passive euthanasia (Tolentino 1973) -supported by a written consent (White 2010;Mace et al 2008;Lin et al 1999) voluntarily signed by either the patient or by the relatives/significant others. The act of discharging is another method of executing a DNR (Doh 2005a) affects decision-making because it is consented and signed by relatives/significant others taking responsibility to bring home their patient against medical advice.…”

Section: The Policy On Do-not-resuscitate Affecting the Decision-makingmentioning

confidence: 99%

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Decision-making Processes for a Do-not-resuscitate Poisoned Pediatric Patient Admitted to the Department of Emergency and Medical Services — A Case Study

Dioso

2017

AJSTD

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The case aims to apply the processes of decision-making to a Do-not-resuscitate (DNR) pediatric patient admitted to the Department of Emergency Medical Services (DEMS) of a state-run hospital located in a low-income country. It also aims to examine and evaluate the case of a 16-year-old female intoxicated pediatric patient to provide her with emergency care, management, diagnostic investigations and treatments. The descriptive, normative and prescriptive models of decision-making (Shaban 2005) are demonstrated and therefore concludes with a sound decision.Ethics of justice were considered and this case study maintained anonymity of patients, healthcare professionals and hospital's name. The purpose is to make a world view on how a sound decision-making is demonstrated in a fast-paced environment. BAckgRouND of ThE STuDyThe state-run hospital used for this study admits more than 180 000 patients per year with over 1000+ bed capacity -admitting an estimated 500+ patients per day (Philippine Statistical Ideas on pertinent literatures of decision-making models, clinical guidelines on poison resuscitation and DNR policies were already known by the majority. In addition, ideas on the benefits such as becoming enlightened on how to make sound judgments in an emergency situation, particularly addressing issues on how to prioritize patients waiting in the emergency departments were featured.Poison resuscitations were decided upon by using the descriptive, normative and prescriptive clinical decision-making models in a fast-paced environment. But the most important outcome however, was the recognition of client/relative satisfaction from hospital services -the demonstration of a sound decision-making that is legally, physiologically and financially in tandem with patient needs.

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Clinical Policy: Critical Issues in the Sedation of Pediatric Patients in the Emergency Department

Cited by 79 publications

References 181 publications

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

Pediatric applied trauma research network: a call to action

Decision-making Processes for a Do-not-resuscitate Poisoned Pediatric Patient Admitted to the Department of Emergency and Medical Services — A Case Study

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