A recent audit conducted by the Royal College of Emergency Medicine (RCEM) in 2018 revealed a concerning decline in the standards of pain management for children with fractured limbs in Emergency Departments (EDs). The audit found that the majority of patients experienced longer waiting times for pain relief compared to previous years. Shockingly, more than 1 in 10 children who presented with significant pain due to a limb fracture did not receive any pain relief at all.

To address this issue, the Agency for Health Care Policy and Research (AHCPR) in the USA recommends following the ABCs of pain management for all patients, including children. This approach involves regularly asking about pain, systematically assessing it, believing the patient and their family in their reports of pain and what relieves it, choosing appropriate pain control options, delivering interventions in a timely and coordinated manner, and empowering patients and their families to have control over their pain management.

The RCEM has established standards that require a child’s pain to be assessed within 15 minutes of their arrival at the ED. This is considered a fundamental standard. Various rating scales are available for assessing pain in children, with the choice depending on the child’s age and ability to use the scale. These scales include the Wong-Baker Faces Pain Rating Scale, Numeric rating scale, and Behavioural scale.

To ensure timely administration of analgesia to children in acute pain, the RCEM has set specific standards. These standards state that 100% of patients in severe pain should receive appropriate analgesia within 60 minutes of their arrival or triage, whichever comes first. Additionally, 75% should receive analgesia within 30 minutes, and 50% within 20 minutes.

The prolonged use of nitrous oxide (Entonox) in patients with sepsis may have a negative impact on DNA synthesis, and it is not recommended to use it in this situation. However, sepsis itself does not prevent the use of nitrous oxide.

There are several conditions that make the use of nitrous oxide inappropriate. These include a reduced level of consciousness, diving injuries, pneumothorax, middle ear disease, sinus disease, bowel obstruction, a documented allergy to nitrous oxide, hypoxia, and violent or disabled psychiatric patients.

It is important to note that the use of nitrous oxide should be avoided in patients with sepsis due to its potential effects on DNA synthesis. However, there are other contraindications to its use that should be considered in different clinical scenarios.

A recent audit conducted by the Royal College of Emergency Medicine (RCEM) in 2018 revealed a concerning decline in the standards of pain management for children with fractured limbs in Emergency Departments (EDs). The audit found that the majority of patients experienced longer waiting times for pain relief compared to previous years. Shockingly, more than 1 in 10 children who presented with significant pain due to a limb fracture did not receive any pain relief at all.

To address this issue, the Agency for Health Care Policy and Research (AHCPR) in the USA recommends following the ABCs of pain management for all patients, including children. This approach involves regularly asking about pain, systematically assessing it, believing the patient and their family in their reports of pain and what relieves it, choosing appropriate pain control options, delivering interventions in a timely and coordinated manner, and empowering patients and their families to have control over their pain management.

The RCEM has established standards that require a child’s pain to be assessed within 15 minutes of their arrival at the ED. This is considered a fundamental standard. Various rating scales are available for assessing pain in children, with the choice depending on the child’s age and ability to use the scale. These scales include the Wong-Baker Faces Pain Rating Scale, Numeric rating scale, and Behavioural scale.

To ensure timely administration of analgesia to children in acute pain, the RCEM has set specific standards. These standards state that 100% of patients in severe pain should receive appropriate analgesia within 60 minutes of their arrival or triage, whichever comes first. Additionally, 75% should receive analgesia within 30 minutes, and 50% within 20 minutes.

Each milliliter of plain 1% lidocaine solution contains 10 milligrams of lidocaine hydrochloride.

A recent audit conducted by the Royal College of Emergency Medicine (RCEM) in 2018 revealed a concerning decline in the standards of pain management for children with fractured limbs in Emergency Departments (EDs). The audit found that the majority of patients experienced longer waiting times for pain relief compared to previous years. Shockingly, more than 1 in 10 children who presented with significant pain due to a limb fracture did not receive any pain relief at all.

To address this issue, the Agency for Health Care Policy and Research (AHCPR) in the USA recommends following the ABCs of pain management for all patients, including children. This approach involves regularly asking about pain, systematically assessing it, believing the patient and their family in their reports of pain and what relieves it, choosing appropriate pain control options, delivering interventions in a timely and coordinated manner, and empowering patients and their families to have control over their pain management.

The RCEM has established standards that require a child’s pain to be assessed within 15 minutes of their arrival at the ED. This is considered a fundamental standard. Various rating scales are available for assessing pain in children, with the choice depending on the child’s age and ability to use the scale. These scales include the Wong-Baker Faces Pain Rating Scale, Numeric rating scale, and Behavioural scale.

To ensure timely administration of analgesia to children in acute pain, the RCEM has set specific standards. These standards state that 100% of patients in severe pain should receive appropriate analgesia within 60 minutes of their arrival or triage, whichever comes first. Additionally, 75% should receive analgesia within 30 minutes, and 50% within 20 minutes.

A recent audit conducted by the Royal College of Emergency Medicine (RCEM) in 2018 revealed a concerning decline in the standards of pain management for children with fractured limbs in Emergency Departments (EDs). The audit found that the majority of patients experienced longer waiting times for pain relief compared to previous years. Shockingly, more than 1 in 10 children who presented with significant pain due to a limb fracture did not receive any pain relief at all.

To address this issue, the Agency for Health Care Policy and Research (AHCPR) in the USA recommends following the ABCs of pain management for all patients, including children. This approach involves regularly asking about pain, systematically assessing it, believing the patient and their family in their reports of pain and what relieves it, choosing appropriate pain control options, delivering interventions in a timely and coordinated manner, and empowering patients and their families to have control over their pain management.

The RCEM has established standards that require a child’s pain to be assessed within 15 minutes of their arrival at the ED. This is considered a fundamental standard. Various rating scales are available for assessing pain in children, with the choice depending on the child’s age and ability to use the scale. These scales include the Wong-Baker Faces Pain Rating Scale, Numeric rating scale, and Behavioural scale.

To ensure timely administration of analgesia to children in acute pain, the RCEM has set specific standards. These standards state that 100% of patients in severe pain should receive appropriate analgesia within 60 minutes of their arrival or triage, whichever comes first. Additionally, 75% should receive analgesia within 30 minutes, and 50% within 20 minutes.

Lidocaine is a tertiary amine that is primarily utilized as a local anesthetic. It can also be employed in the treatment of ventricular arrhythmias. The mechanism of action of lidocaine as a local anesthetic involves its diffusion in the form of an uncharged base through neural sheaths and the axonal membrane. It then reaches the internal surface of the cell membrane sodium channels, where it exerts its effect by blocking the fast voltage-gated sodium channels. This alteration in signal conduction prevents the depolarization of the postsynaptic neuron’s membrane, thereby inhibiting the transmission of pain signals.

In a plain 1% lidocaine solution, each 1 ml contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg, with a maximum limit of 200 mg. However, when administered with adrenaline in a 1:200,000 ratio, the maximum safe dose increases to 7 mg/kg, with a maximum limit of 500 mg. It is important to note that the combination of lidocaine and adrenaline should not be used in extremities such as fingers, toes, and the nose due to the risk of vasoconstriction and tissue necrosis.

The half-life of lidocaine ranges from 1.5 to 2 hours. It exhibits a rapid onset of action within a few minutes and has a duration of action of 30 to 60 minutes when used alone. However, when co-administered with adrenaline, its duration of action is prolonged. It is worth mentioning that lidocaine tends to induce vasodilation, primarily attributed to the inhibition of action potentials in vasoconstrictor sympathetic nerves through the blocking of sodium channels.

A recent audit conducted by the Royal College of Emergency Medicine (RCEM) in 2018 revealed a concerning decline in the standards of pain management for children with fractured limbs in Emergency Departments (EDs). The audit found that the majority of patients experienced longer waiting times for pain relief compared to previous years. Shockingly, more than 1 in 10 children who presented with significant pain due to a limb fracture did not receive any pain relief at all.

To address this issue, the Agency for Health Care Policy and Research (AHCPR) in the USA recommends following the ABCs of pain management for all patients, including children. This approach involves regularly asking about pain, systematically assessing it, believing the patient and their family in their reports of pain and what relieves it, choosing appropriate pain control options, delivering interventions in a timely and coordinated manner, and empowering patients and their families to have control over their pain management.

The RCEM has established standards that require a child’s pain to be assessed within 15 minutes of their arrival at the ED. This is considered a fundamental standard. Various rating scales are available for assessing pain in children, with the choice depending on the child’s age and ability to use the scale. These scales include the Wong-Baker Faces Pain Rating Scale, Numeric rating scale, and Behavioural scale.

To ensure timely administration of analgesia to children in acute pain, the RCEM has set specific standards. These standards state that 100% of patients in severe pain should receive appropriate analgesia within 60 minutes of their arrival or triage, whichever comes first. Additionally, 75% should receive analgesia within 30 minutes, and 50% within 20 minutes.

The maximum safe dose of plain lidocaine is 3 mg per kilogram of body weight, with a maximum limit of 200 mg. However, when lidocaine is administered with adrenaline in a 1:200,000 ratio, the maximum safe dose increases to 7 mg per kilogram of body weight, with a maximum limit of 500 mg.

In this particular case, the patient weighs 50 kg, so the maximum safe dose of lidocaine hydrochloride would be 50 multiplied by 3 mg, resulting in a total of 150 mg.

For more detailed information on lidocaine hydrochloride, you can refer to the BNF section dedicated to this topic.

Lidocaine is a tertiary amine that is primarily utilized as a local anesthetic. It can also be employed in the treatment of ventricular arrhythmias. The mechanism of action of lidocaine as a local anesthetic involves its diffusion in the form of an uncharged base through neural sheaths and the axonal membrane. It then reaches the internal surface of the cell membrane sodium channels, where it exerts its effect by blocking the fast voltage-gated sodium channels. This alteration in signal conduction prevents the depolarization of the postsynaptic neuron’s membrane, thereby inhibiting the transmission of pain signals.

In a plain 1% lidocaine solution, each 1 ml contains 10 mg of lidocaine hydrochloride. The maximum safe dose of plain lidocaine is 3 mg/kg, with a maximum limit of 200 mg. However, when administered with adrenaline in a 1:200,000 ratio, the maximum safe dose increases to 7 mg/kg, with a maximum limit of 500 mg. It is important to note that the combination of lidocaine and adrenaline should not be used in extremities such as fingers, toes, and the nose due to the risk of vasoconstriction and tissue necrosis.

The half-life of lidocaine ranges from 1.5 to 2 hours. It exhibits a rapid onset of action within a few minutes and has a duration of action of 30 to 60 minutes when used alone. However, when co-administered with adrenaline, its duration of action is prolonged. It is worth mentioning that lidocaine tends to induce vasodilation, primarily attributed to the inhibition of action potentials in vasoconstrictor sympathetic nerves through the blocking of sodium channels.