Sedoanalgesia Versus Infraclavicular Block for Closed Reduction of Pediatric Forearm Fracture in Emergency Department: Prospective Randomized Study

No-anesthesia for Colles fracture

BACKGROUND

This study aims to measure the perceived pain during the reduction of Colles fracture without anesthesia in both children and adults. It describes the process and reveals duration for reduction, total hospital stays and compares them with the same procedure under hematoma block.

METHODS

We employed the Wong-Baker FACES pain scale to assess pain reduction in 135 adults and 98 pediatric patients undergoing Colles fracture reduction with or without hematoma block. We also measured the time required for the reduction and the overall process.

RESULTS

For fracture reduction without anesthesia, Wong-Baker FACES scores were 9.2 for children and 8.7 for adults. With hematoma block, scores dropped to 7.5 for children and 5.2 for adults with only a 10 min addition to the hospital stay. Pain scores among pediatric patients exhibited moderate to strong negative correlations with age. The reduction maneuver itself took an average of 5 s.

CONCLUSIONS

The reduction of a Colles fracture is nearly instantaneous, making the reduction without anesthesia tolerable. Pediatric patients don't benefit from hematoma block as much as adult counterparts. It significantly reduced pain scores by 1.7 points in children and 3.5 points in adults.

LEVEL OF EVIDENCE

Level I, Randomized Controlled Trial.

Building Blocks-A Block-by-Block Approach to Better Emergency Care in Children

OBJECTIVE

We describe a case series of regional nerve blocks, which comprise an adapted framework for the pediatric emergency setting and were performed by pediatric emergency medicine physicians.

METHODS

A case series of 8 different ultrasound-guided nerve blocks and 1 anatomical block, performed in 11 pediatric patients, aged 7 weeks to 17 years.

RESULTS

All blocks resulted in adequate analgesia. No procedural complications were observed.

CONCLUSION

We describe a set of nerve blocks performed by emergency medicine physicians in the pediatric population in an ED setting. In suitable settings, this is a safe and effective tool for procedural analgesia or for pain management. In such cases, performing an ultrasound-guided nerve block in the ED is a viable alternative for repeated doses of opiates, deep procedural sedation, or the operating theater. We propose this set of regional anesthesia procedures as a pediatric-adapted toolkit for the emergency physician to be performed in children in the ED setting. Adopting this set of procedures ensures better and safer care for children and provides a training framework for pediatric ED physicians.

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

PURPOSE OF REVIEW

There is expanding evidence for point-of-care ultrasound (POCUS) use in pediatric emergency medicine - this review highlights the benefits and challenges in the clinical integration of high-yield POCUS applications. Specifically, it will delve into POCUS applications during resuscitations, controversies of Focused Assessment with Sonography for Trauma (FAST) in pediatric trauma, POCUS-guided procedures, and examples of clinical pathways where POCUS can expedite definitive care.

RECENT FINDINGS

POCUS can enhance diagnostic accuracy and aid in management of pediatric patients in shock and help identify reversible causes during cardiac arrest. The use of the FAST in pediatric blunt abdominal trauma remains nuanced - its proper use requires an integration with clinical findings and an appreciation of its limitations. POCUS has been shown to enhance safety and efficacy of procedures such as nerve blocks, incision & drainage, and intravenous access. Integrating POCUS into pathways for conditions such as intussusception and testicular torsion expedites downstream care.

SUMMARY

POCUS enhances diagnostic efficiency and management in pediatric patients arriving at the ED with undifferentiated shock, cardiac arrest, or trauma. Additionally, POCUS improves procedural success and safety, and is integral to clinical pathways for expediting definitive care for various pediatric emergencies. Future research should continue to focus on the impact of POCUS on patient outcomes, ensuring user competency, and the expansion of POCUS into diverse settings.