Emergency Department Management of Pain and Anxiety Related to Orthopedic Fracture Care

Abstract

Orthopedic fractures and joint dislocations are among the most painful pediatric emergencies. Safe and effective management of fracture-related pain and anxiety in the emergency department reduces patient distress during initial evaluation and often allows definitive management of the fracture. No consensus exists on which pharmacologic regimens for procedural sedation/analgesia are safest and most effective. For some children, control of fracture pain is the primary goal, whereas for others, relief from anxiety is an additionally important objective. Furthermore, strategies for the management of fracture pain may vary by fracture location and patient characteristics; thus, no single regimen is likely to provide the best means of analgesia and anxiolysis for all patients. Effective analgesia can be provided by local or regional anesthesia, such as hematoma, Bier, or nerve blocks. Alternatively, induction of deep sedation with analgesic agents such as ketamine or fentanyl, often combined with sedative-anxiolytic agents such as midazolam, may be used to manage distress associated with fracture reduction. A combination of local anesthesia with moderate sedation, for example nitrous oxide, is another attractive option.

Physician Pain Reminder as an Intervention to Enhance Analgesia for Extremity and Clavicle Injuries in Pediatric Emergency

“…2,23,29 Emergency physicians often fail to recognize pain and fall short of treating painful conditions appropriately. 8,17,29 Limb and clavicle injuries are among the most painful pediatric emergencies, 15 and inadequate pain management leads to unnecessary suffering. Prompt assessment and effective management not only reduce patient distress and improve quality of care, but they also increase pediatric ED satisfaction.…”

Simulation and Web-based learning increases utilization of Bier block for forearm fracture reduction in the pediatric emergency department

“…However, to our knowledge, no other BB training course has been described previously, and we have used consensus-based guidelines and best-evidence practice recommendations to guide course content. [13][14][15][16] Finally, our study did not assess patient-centered and orthopedic quality measures in the post-implementation period. Although these outcomes are beyond the scope of the current study, they remain an important area of future research.…”

“…[13][14][15][16] Participants completed a pre-course, self-directed, Web-based learning module prior to attendance of a complementary simulation-based training session. The online learning component provided an overview of the BB technique and reviewed potential adverse events using text, illustrations, and video.…”

Pain Management for the Hospitalized Pediatric Patient

“…Brief diagnostic and therapeutic procedures are a major aspect of pediatric hospital practice [135][136][137][138]. Every hospital that cares for children should develop a regular multi-tiered program for management of these procedures.…”