Book contents
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- 1 Emergency Analgesia Principles
- 2 Emergency Procedural Sedation Principles
- 3 Analgesic and Procedural Sedation Principles Unique to the Pediatric Emergency Department
- 4 Pain and Analgesia in the Infant
- 5 Provider Bias and Patient Selection for Emergency Department Procedural Sedation and Analgesia
- 6 Federal and Hospital Regulatory Oversight in Emergency Department Procedural Sedation and Analgesia
- 7 Nursing Considerations in Emergency Department Procedural Sedation and Analgesia
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
3 - Analgesic and Procedural Sedation Principles Unique to the Pediatric Emergency Department
from SECTION ONE - OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
Published online by Cambridge University Press: 03 December 2009
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- 1 Emergency Analgesia Principles
- 2 Emergency Procedural Sedation Principles
- 3 Analgesic and Procedural Sedation Principles Unique to the Pediatric Emergency Department
- 4 Pain and Analgesia in the Infant
- 5 Provider Bias and Patient Selection for Emergency Department Procedural Sedation and Analgesia
- 6 Federal and Hospital Regulatory Oversight in Emergency Department Procedural Sedation and Analgesia
- 7 Nursing Considerations in Emergency Department Procedural Sedation and Analgesia
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
Summary
SCOPE OF THE PROBLEM
Analgesia and sedation of infants, children, and adolescents occur on a daily basis in pediatric emergency departments (EDs) across the country. Some of the most important aspects of safely providing pain relief and/or analgesia for painful procedures or sedation/anxiolysis for nonpainful procedures in children are
an understanding of the definitions used for sedation of children
proper presedation assessment
methods of pain assessment
the presence of properly trained personnel and monitoring devices
age-appropriate equipment
postprocedure assessment and discharge instructions.
The terminology commonly used includes those defined by the American Society of Anesthesiologists (ASA) for minimal sedation or anxiolysis, moderate sedation, deep sedation, and general anesthesia. An appropriate addition to this structure for the pediatric population is dissociative sedation, which is the trance-like state and analgesia induced by ketamine. This state allows for retention of protective airway reflexes and spontaneous respirations.
There are numerous guidelines that exist for procedural sedation and analgesia (PSA) in children, including those developed for sedation by nonanesthesiologists by the American Society of Anesthesiologists and the American Academy of Pediatrics (AAP).
The American College of Emergency Physicians has a clinical policy on procedural sedation and analgesia (PSA), as well as a policy on pharmacologic agents used in pediatric PSA.
Since the Joint Commission on Accreditation of Healthcare Organization (JCAHO) developed standards for pain management and sedation, hospitals that are certified by this organization must adhere to these guidelines.
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- Chapter
- Information
- Emergency Sedation and Pain Management , pp. 11 - 17Publisher: Cambridge University PressPrint publication year: 2008