Pediatric clinics of North America
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Pediatr. Clin. North Am. · Jun 2000
ReviewOffice-based pain management. The 15-minute consultation.
Pain is a ubiquitous component of pediatric illness and injury. Unfortunately, the treatment of pain has remained secondary to the diagnosis and treatment of the disease state. ⋯ Presently available modalities, when used appropriately, can significantly reduce the pain associated with medical encounters. Careful attention to such approaches may reduce the anxiety about pain, which is often an undercurrent at most health care visits, and allows clinicians and children to focus on getting well and staying healthy.
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The challenge for emergency medicine physicians in the new millennium is to use these drugs and drug combinations to make ED visits pain-free and safe experiences. With dedication to research, a willingness to take the time to explore new options, and expansion of pharmacologic and nonpharmacologic interventions, physicians can make this lofty dream a reality.
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Pediatr. Clin. North Am. · Jun 2000
ReviewWeak analgesics and nonsteroidal anti-inflammatory agents in the management of children with acute pain.
The PSIs include acetaminophen, NSAIDs, and salicylates. They can be used alone for the treatment of mild pain or as an adjunct to opioid analgesia. In children, most experience is with acetaminophen and ibuprofen. ⋯ When using oral analgesics, factors that may interfere with effective analgesia include a child's refusal to take the medication, ineffective doses and dosing regimens, decreased bioavailability following PO administration, inability to tolerate PO medications because of nausea or vomiting, altered GI motility, and a delayed onset caused by slow absorption. With such caveats in mind, the PO route provides an effective and cost-effective means for many patients. It should be considered as the primary route for pediatric patients in the treatment of mild to moderate pain, even in the hospital setting.
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Pediatr. Clin. North Am. · Dec 1999
ReviewThe "ouchless emergency department". Getting closer: advances in decreasing distress during painful procedures in the emergency department.
Painful and frightening injuries and illnesses are frequent reasons for children to seek care in an emergency department. Painful therapeutic procedures are often a necessary part of emergency care and are very distressful for the children, their parents, and healthcare providers. Inadequately relieved pain and distress have acute and long-term consequences, yet methods for pain and anxiety reduction during frightening minor and major procedures are often not used because of lack of detailed knowledge of techniques and fear of adverse effects. This article reviews psychologic and pharmacologic means of safe and effective reduction of anxiety and pain during emergency department procedures.
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Minor head injury is a common occurrence in children of all ages; however, controversy exists regarding the management of these children. Reports of neurologically intact children with intracranial injuries have caused many to recommend cautious management, while the infrequency of serious intracranial injuries after minor head trauma have prompted others to be less conservative. Based on recent literature reports, strategies for the management of children with minor head trauma are presented.