FriarMedic Posted June 1, 2016 Share Posted June 1, 2016 How often are you sedating kids in your shop for procedures like facial lacs that just need a few sutures? I feel like we rarely sedate these kids and often it seems quite torturous for them being held down. the time and risk to do a full conscious sedation is burdensome. I had a child the other day that was of a borderline age where you'd expect more control and turned out to be difficult to manage while repairing a facial lac. Looking back it would have been much more helpful for me and far less stressful for the patient to have been sedated. Are you doing conscious sedations with consent form and the whole 9 yards which will then also require an attending or just a little IM versed or morphine? I need a new strategy. Link to comment Share on other sites More sharing options...
YoungH89 Posted June 3, 2016 Share Posted June 3, 2016 I hear intranasal versed is a good choice; no IV needed fast on fast off . I don't work peds so haven't tried it myself. Link to comment Share on other sites More sharing options...
YoungH89 Posted June 3, 2016 Share Posted June 3, 2016 If interested : http://emed.ie/Analgesia/_img/in_midazolam.pdf Link to comment Share on other sites More sharing options...
Boatswain2PA Posted June 7, 2016 Share Posted June 7, 2016 I refuse to torture kids this way. Ketamine is my favorite sedation. 1 mg/kg IV and they are walking out of the ED about 2 hours later. I've done IM (2-3 mg/kg) but that takes longer to work, and lasts forever. I haven't used intranasal versed. Tried PO and IV benzos in past and just wound up with drunk kids. Link to comment Share on other sites More sharing options...
DawnMcBride Posted June 9, 2016 Share Posted June 9, 2016 I used not to implement sedatives on children years ago, it was just 4th year of work, and now it is pretty terrible to me to even think of that. We should definitely use some light sedatives. Now, I tend to use more Ketamine. Have no issues with it by far. Link to comment Share on other sites More sharing options...
sk732 Posted June 9, 2016 Share Posted June 9, 2016 I refuse to torture kids this way. Ketamine is my favorite sedation. 1 mg/kg IV and they are walking out of the ED about 2 hours later. I've done IM (2-3 mg/kg) but that takes longer to work, and lasts forever. I haven't used intranasal versed. Tried PO and IV benzos in past and just wound up with drunk kids. I like IM ketamine - it's usually got a pretty quick onset and reasonably quick egress from the system in my experience, don't have to panic the kid about an IV stick, since you can sneak an IM injection in with a bit of distraction. The problem of course is the parents often make the kid freak out more. Here's a pediatric guideline used by British Columbia Children's Hospital in Vancouver...http://childhealthbc.ca/files/BC%20Childrens%20Hospital%20Emergency%20Department%20Guidelines/Procedural%20Sedation/Guideline%20for%20Pediatric%20Procedural%20Sedation%20and%20Analgesia%20in%20the%20Emergency%20Department.pdf Link to comment Share on other sites More sharing options...
Reality Check 2 Posted June 9, 2016 Share Posted June 9, 2016 I think we should be able to give the parents a versed lollipop as well. I make all parents SIT DOWN during any procedure as one, many years ago, became a head lac from passing out on the ER floor while I sewed kiddo's noggin up. Not doing kid procedures at this point in a private office - just mole biopsies on adults and the occasional walk in garage disaster laceration. One trick with kids - a dollar store pinwheel - brightly colored and sparkly. We had them blow on it to get it to spin while we gave an injection or even started an IV. It works pretty well. I have never been in a place to use EMLA or topical much of anything - takes too long and not entirely effective. My cats got ketamine on an airplane..... that was fun. Link to comment Share on other sites More sharing options...
sk732 Posted June 12, 2016 Share Posted June 12, 2016 One trick with kids - a dollar store pinwheel - brightly colored and sparkly. We had them blow on it to get it to spin while we gave an injection or even started an IV. It works pretty well. I have never been in a place to use EMLA or topical much of anything - takes too long and not entirely effective. . I did my peds rotation at Sick Kids in Toronto in the ER there - as students, since we couldn't do anything without talking to an attending, senior EM resident or Peds EM Fellow, we used to walk around with a tube of EMLA to smear on the kids' likely IV/blood draw sites - would have kicked in by the time the orders were done. I still keep a tube of EMLA in my pocket for what I think are going to be problem kidlets...unless they're really sick, then we don't worry about it of course. I did 2 pretty horrible lacs on kids yesterday - one on a ten year old and the other on a seven...both handled the freezing well (I put LET in the 7 yo's wound first), but the 40 year old I sewed up earlier almost needed a GA because of acute wussyitis. SK Link to comment Share on other sites More sharing options...
ajnelson Posted June 18, 2016 Share Posted June 18, 2016 I'm a huge fan of ketamine for kiddos as well. Just used it the other night. Simple IM injection that the kids don't even typically remember. I find it has a pretty quick onset, less than 5 minutes and is long enough for me to adequately clean, repair and dress or splint, so I'm not worrying about it wearing off too early Link to comment Share on other sites More sharing options...
FriarMedic Posted June 18, 2016 Author Share Posted June 18, 2016 I'm a huge fan of ketamine for kiddos as well. Just used it the other night. Simple IM injection that the kids don't even typically remember. I find it has a pretty quick onset, less than 5 minutes and is long enough for me to adequately clean, repair and dress or splint, so I'm not worrying about it wearing off too early When you do this, is it considered moderate sedation? Ie- requiring written consent, monitor, O2 on, second provider, ect? Link to comment Share on other sites More sharing options...
ajnelson Posted June 18, 2016 Share Posted June 18, 2016 When you do this, is it considered moderate sedation? Ie- requiring written consent, monitor, O2 on, second provider, ect? Yes, it is moderate sedation, we use monitor and ETCO2, respiratory at bedside. (I always remind my team, biggest thing to worry about is increased secretions in the airway, and make sure we have suction. We don't have the requirement for a second provider to be in the room, but, we have a yearly procedural sedation class we have to take. Some of the sites I cover, we are solo coverage, so, it takes time to call a second provider in (either the CRNA or the MD backup) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 18, 2016 Moderator Share Posted June 18, 2016 I use 4 mg/kg im for ketamine or 1-1.5 mg/kg iv or nasal. agree with Boats and AJ. Ketamine is the bomb! Link to comment Share on other sites More sharing options...
Boatswain2PA Posted July 11, 2016 Share Posted July 11, 2016 ...biggest thing to worry about is increased secretions in the airway, and make sure we have suction.... I always preload kids with a touch of atropine. Link to comment Share on other sites More sharing options...
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