Going to the emergency room to have a laceration repaired is common, but for children it can be traumatic. Imagine you’re injured and bleeding, you’re in pain, and you’re rushed to the hospital ER, a place with bright lights and sometimes scary sights. You get a shot, a doctor approaches you with an odd-looking needle and thread, and a group of adults pins you down to hold you still for suturing. It’s terrifying, and for many children the ER experience is far more distressing than the original injury, potentially leaving long lasting psychological scars.
At St. Clair Hospital, emergency medicine physicians have essentially eliminated that scenario by implementing an innovative and painless approach to the treatment of certain acute injuries in children. Safe, effective and humane, the new method employs nasal inhalation to administer medication that calms and quiets children so they can be treated.
“It can be terrifying for a child to be pinned down by adults,” says St. Clair ER physician Emily Brown, MD. “We’re pleased that we can now give a child a pain-free experience. We use it primarily for treating lacerations and fractures and for imaging procedures, and we’ve had excellent results. It allows the child to lie still, and that makes it easier for the staff to complete the suturing.”
Dr. Brown describes the procedure: “ER nurses apply topical Lidocaine, an anesthetizing agent, to the skin upon the child’s arrival. This numbs the area and eases any pain. Once it takes effect, we use a nasal atomizer to deliver a carefully calibrated dose of anti-anxiety medication into each nostril. The child is monitored throughout with nurses keeping track of vital signs and oxygen saturation. After 10 minutes, the child is sufficiently calm. The effect lasts for 30 to 40 minutes and is well tolerated.
“No needles, no restraining, no IV, no pain—this is an ideal way to treat lacerations in children. Instead of being sedated or pinned down on a table, the child can quietly sit on a parent’s lap. Most often we treat children in our Fast Track room. We see lots of active, healthy kids who get injured; they can be treated here painlessly and efficiently.”
St. Clair’s pharmacy department worked closely with ER staff to develop the protocol and reformulate topical Lidocaine for this purpose. St. Clair administrators were supportive and helpful with implementation, and Raymond D. Pitetti, M.D., associate chief of emergency medicine at Children’s Hospital of Pittsburgh of UPMC, an expert in pediatric sedation, shared his knowledge and experience with the technique with St. Clair’s ER physicians.
“This is a wonderful service for the community; parents can count on being in and out of the ER quickly,” says Dr. Brown. “As an emergency medicine physician, and as a mother, I know the value of this new approach.”