Really great. Do you guys have an actual triage protocol, or do you simply do this informally? If
you or anyone out there has a protocol could you email it to me, would be quite helpful...
Univ of Az
Sarah Epstein/Sandy Hopper wrote:
> ouchlessness vs convenience
> There needs to be a good reason not to use local anaesthetic preparations in a child whose
> condition can wait the hour or so for EMLA to work.
> In fact the ability of the triage nurses to predict a doctor's intention to venesect or start an
> IV is high.
> In the situation where we need to wait, I give the child (or occasionally the parents) the choice,
> and see another patient or two in the meantime.
> In our department, doctors do all IVs and bloods, and with experience the skin changes induced by
> the creams form no impediment to identification and cannulation of veins. The cost of patches or
> cream is insignificant.
> The conclusion: with-holding EMLA or the like is cruel and uncaring.
> We need to remind ourselves that we are advocates for the children for whom we care.
> Sandy Hopper,
> Fellow Ped EM
> Sydney Children's Hospital.
> virgil wrote:
> > I find it interesting that nurses seem to always feel that anything before
> > starting iv's is not worth the effort, that it somehow makes vein
> > visualization difficult, and that its just not a big deal to start the iv.
> > I find the literature to be contrary to these notions. Quite a bit of
> > anesthesia literature finds that a bunch of stuff like buffered lidocaine
> > injected, flourimethane spray, EMLA, etc really decreases pain without
> > decreasing first and second stick sucess rates in randomized trials. My
> > own experience (as one of a few MD's here that start IV's) with older
> > children and adults is that using buffered lidocaine is very helpful to the
> > patient and doesn't make the iv start any harder. Emla is the same except
> > it takes forever. I think that a little combination of resistance to
> > change and desensitivation to patient discomfort on the part of the nursing
> > staff makes implementation of proven methods to decrease discomfort
> > difficult. Also since most ED MD's are horrid at IV starts I've heard the
> > arguement often ended by some comment by the nurses that the physicians
> > don't really understand and that they're really good and don't need this
> > other stuff, etc. When my patients request numbing medicine (since many
> > repeat pts have had iv's by anesthesia) I just do it myself instead of
> > argue anymore.
> > Intersted if anyone's nursing staff has latched onto either emla or
> > injected lidocaine or cold sprays/etc...???
> > Virgil Davis, MD
> > At 08:06 AM 12/21/99 -0600, Jay Pershad wrote:
> > >Dr. Fisher:
> > >
> > >We use it in our ED. I tend to use it mainly for LP's. I still have to use
> > >injectable Lidocaine to anesthetize the deeper tissues( ligaments and dura).
> > >With Numby, the entire LA can become painless. I prefer it to EMLA for 2
> > >reasons. One is, the time to onset, which is only 10 minutes, as opposed to
> > >45 minutes to an hour with EMLA. Secondly, the depth of LA is greater with
> > >Numby (upto 10 mm as opposed to 5-6 mm with EMLA).
> > >
> > >The nurses in our ED our divided on it use for IV starts. Some of the more
> > >experienced ones seem to prefer to just go ahead and start the IV in one
> > >stick. They find that 10 minutes of Numby with its attendant "burning" at
> > >the site is not worth it. Moreover, they feel that the Epi in Numby causes
> > >vasoconstriction and impedes proper vein visualization.
> > >
> > >I have not reviewed the data to comment on its success or efficacy. For a
> > >very anxious "needle-phobic" patient it may have a role.
> > >
> > >Jay
> > >Jay Pershad, M.D.
> > >Lebonheur Childrens's Medical Center
> > >Memphis, TN
> > >
> > >For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > >The URL for the PED-EM-L Web Page is:
> > > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
> > >
> > For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: