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"Morphine for everyone" requires IV access...
Though it has not been studied for this specific indication intranasal
fentanyl seems like the obvious solution - powerful drug, minimal AE, rapid
onset, no IV needed



Franz E Babl
Paediatric Emergency Physician, Emergency Department
Group leader, Emergency Research, Murdoch Children's Research Institute
Clinical Associate Professor, University of Melbourne
Royal Children's Hospital
Parkville
VIC 3052
Australia
P 61 3 9345 6061
F 61 3 9345 5938
email [log in to unmask]
 

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Amy Baxter
Sent: Thursday, 8 January 2009 7:03 AM
To: [log in to unmask]
Subject: Re: Triage guidlines for sickle cell disease

Hmmmm    Motrin?

A pediatrician I worked with happened to have HgbSS and two children.  We
were discussing pain control for labor -- she had delivered both kids
naturally.  When I expressed the respect women give other women who have
"gone natural", she taught me more about sickle cell pain than I'd learned
in residency and two fellowships:

	"Labor?!?  Compared to a sickle cell crisis, labor is nothing.
Sickle
cell pain is like having your bone crushed, like your whole world is
focused on something that takes your breath away.  Over time you realize
that crying doesn't help, sucking up to doctors for pain medicine doesn't
help, only trying to put your mind somewhere else can help a little. 
Believe me, after dealing with SS all my life, labor was nothing."

So when children whose parents almost always have oral opioids at home
bring them to the ED for relief, having them wait or offering Motrin just
really isn't fair.  We can't always fix what's wrong with people, but with
the subset of humans who were dealt a definitively crappy hand, let's err
on the side of believing them and on the side of compassion.

Morphine for everyone!!!!

-Amy

William Zempsky <[log in to unmask]> writes:
>Because especially in adult EDs sickle cell patients (adolescents and
>adults) can languish in the waiting room for hours.  Early and agressive
>managment of sickle cell pain is an effective method to prevent
>hospitalization, and there is an emerging body of evidence that
>coinciding with pain episodes is end organ damage from sickling. 
>Agressive treatment may diminish this as well (not yet proven)
>
>Bill
>
>
>William T. Zempsky, MD
>Associate Director, Pain Relief Program
>Connnecticut Children's Medical Center
>282 Washington Street
>Hartford, CT 06106
>860-545-9041
>Fax 860-545-9969
>[log in to unmask]
>>>> "Martin Herman, M.D." <[log in to unmask]> 01/07/09 12:20 PM >>>
>WHy a triage level 2 . I think some patients can be handled as triage
>3,especially if you allow the triage nurses to administer motrin in the
>WR.
>
>Marty
>
>
>On Wed, Jan 7, 2009 at 9:09 AM, William Zempsky
><[log in to unmask]>wrote:
>
>> My colleagues and I in connecticut are tryng to develop statewide
>> guidelines for triage of patients with sickle cell disease.  These
>guidlines
>> will target both adult and pedatric facilities.
>>
>> There appears to be a wide range of approaches to this issue especially
>in
>> adult EDS
>>
>> As a first step I would like to get all EDs in our state assgning all
>> sickle cell patients who present with pain to level 2 triage status.  I
>am
>> looking for published triage guidelines from national/international
>> organizations which list sickle cell pain as a level 2 triage criteria.
>>  Please contact me if you know of any.  Thanks.
>>
>> Bill
>>
>> William T. Zempsky, MD
>> Associate Director, Pain Relief Program
>> Connnecticut Children's Medical Center
>> 282 Washington Street
>> Hartford, CT 06106
>> 860-545-9041
>> Fax 860-545-9969
>> [log in to unmask]
>>
>> 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://listserv.brown.edu/ped-em-l.html
>>
>
>
>
>-- 
>Marty
>Martin Herman, M.D.
>Pediatric Emergency Specialists, P.C.
>Lebonheur Children's Medical Center
>Memphis Tn 38103
>
>901 287 5986 ( ED office)
>901 287 6226 ( ED fax)
>
>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://listserv.brown.edu/ped-em-l.html



Amy Baxter MD
Pediatric Emergency Medicine Associates
404 371-1190


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://listserv.brown.edu/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://listserv.brown.edu/ped-em-l.html