On 2/10/95, Dan Ward wrote:
>Unless the laceration is very large (and only a shinto priest can tell us what
>very and large mean), would require infiltration instead of topical, requires
>long periods of not moving, etc, I would not sedate. We use TAC quite
>and have found rare complication, and those esentially limited to rare
>Politically incorrect philosophy, I'm not sure that life is meant to be totally
>without anxiety and pain. Yes, I relieve pain in my practice, but I think that
>we perseverate to the extreme, sometimes, on not causing anxiety or discomfort
>in our patients. Eg. Parents that refuse to allow rectal temps in an otherwise
>healthy child with a fever. Or that seek a lawyer to sue for sexual assault
>David G. Ward, M.D.
>Le Bonheur, Memphis, Tn
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I think it is worth perseverating in order to raise our level of
awareness about reducing children's anxiety. When this is put into practice
there is still alot of suffering and distress that children undergo during
emergency and other medical care. I just hope we can improve our practices
and influence others to do better.
Does anyone have a good, prospective method of identifying children
who need anxiolysis for laceration repair? You know what I mean. The child
with an otherwise uncomplicated laceration who is not overtly anxious, but
upon wound preparation (and after TAC has worked) loses control. This is
despite psychological techniques that we try to routinely use. If we could
come up with an effective and sensitive method of identifying these kids, it
would help (my) clinical practice.
Is anyone using the topical anesthetic containing lidocaine, epine-
phrine, and tetracaine? This preparation sounds appealing for a variety of
reasons, and we are considering switching to it.
Thomas E. Terndrup, MD
Director, Pediatric Emergency Medicine