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A 10-year-old boy with no significant medical history presented for evaluation after an unwitnessed fall forward from rollerblades onto asphalt. The patient reported no loss of consciousness after the fall and was able to ambulate home. Within an hour, he had developed 3 episodes of nonbloody, nonbilious emesis, vague abdominal pain, and became sleepier, according to his mother. He was brought in by emergency medical services to a level 1 pediatric trauma center, with a cervical collar and backboard in place. He was given a fluid bolus and ondansetron en route to the center. Physical examinationOn arrival (about an hour after the fall), the patient was tachycardic (heart rate, 148 bpm) and tachypneic (respiratory rate, 24 breaths/min), with a normal blood pressure and oxygen saturation level.Findings from the physical examination revealed that the boy was well nourished and alert (Glasgow Coma Scale score, 15), but he was exhibiting excessive sleepiness. He also had generalized abdominal pain with minimal guarding but no distension or overlying bruising. The remainder of the physical examination was unremarkable.

Objectives: Pain control remains suboptimal in pediatric emergency departments (EDs). Only 60% of pediatric patients requiring pain medications receive them in the ED, with an average time of administration being 90 minutes after arrival. Although pain protocols (PP) have been proposed and evaluated in children with long-bone fractures, data on PP utility for general pediatric patients with acute pain are limited. Our objective is to introduce a nursing-initiated PP with medication algorithms for use in triage, measure the improvement in management of severe pain on arrival to the ED and determine the effect on parental satisfaction.Methods: Prospective prestudy and poststudy conducted from June to October 2017. Patients aged 3 to 17 years presenting to a large tertiary pediatric ED with acute pain were eligible. Preprotocol demographics, clinical data, and pain interventions were obtained over a 6-week period. A convenience sample of parents completed a satisfaction survey rating their experience with ED pain management during this time. In the 4-week intervention phase, the PP was introduced to our ED nurses. Postintervention data were collected in the same fashion as the preintervention phase. Analysis was done using independent sample t test and χ 2 models.Results: There were 1590 patients evaluated: preprotocol (n = 816), postprotocol (n = 774). Approximately 10% more patients with severe pain received pain medication in the post-PP sample compared with pre-PP (85.6% and 75.9% respectively). Parental satisfaction was higher in patients who received analgesic medications within 90 minutes of arrival to the ED (P = 0.007). Conclusions:The introduction of a PP in the ED setting improved the treatment of pain. There was a significant increase in patients with severe pain receiving analgesic medications. Additionally, parents were more satisfied if their children received pain medication in a more timely fashion. Pediatric EDs should consider introducing PPs to improve appropriate and timely administration of pain medication in triage.