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Sara and I trained at the same hospital and my understanding of the policy
after talking to one of our head radiologists was that they believe that
the kids bearing down during the procedure makes them reduce easier.

Some of the radiologists at another hospital that I work at actually want
the kids sedated during the procedure.

Thoughts?

Thanks,
Michelle Fleurat MD

On Fri, Jan 23, 2015 at 6:35 PM, Marty Herman <[log in to unmask]> wrote:

> Anyone tried glycopyrrolate? I have and think it helps.
>
> Marty, (Dad, Bro etc.)
> Martin Herman , M.D.
> Sent from my iPhone
>
>
> > On Jan 23, 2015, at 7:45 PM, Meckler, Garth <[log in to unmask]>
> wrote:
> >
> > Great question, thanks for posting.  No restrictions at our institution,
> but I'm curious if there are any pain experts who can comment on whether
> narcotics block nociception from hollow viscous stretch receptors?
> Anecdotally over the years I have tried providing a range of analgesics but
> have not found them very effective for this type of pain.  Even a number of
> studies looking at morphine for appendicitis suggest that, while safe, it
> doesn't significantly change reported pain scores.  Anyone have insights
> into pain control from hollow viscous pain?
> >
> > Garth Meckler, MD, MSHS
> > Division Head, PEM
> > BC Children's Hospital
> >
> >
> >> On Jan 23, 2015, at 15:03, Sara Alexandra Leibovich <
> [log in to unmask]> wrote:
> >>
> >> Hello,
> >> It seems that there is a tradition in radiology about avoiding morphine
> (or
> >> other opioid analgesic) for patients with intussusception prior to
> >> reduction, the idea being that patients who are "too relaxed" are more
> >> likely to perforate during the reduction attempt. At your institution,
> does
> >> radiology request that morphine be withheld from children with
> >> intussusception in the ED? If so, what is their stated reason, and how
> do
> >> you reconcile this with the obvious need for pain control? On the other
> >> hand, at your institution, are reductions normally done with a dose of
> >> morphine or similar on board, or under procedural sedation? Is there any
> >> formal policy?
> >>
> >> Thanks,
> >> Sara Leibovich
> >>
> >> Fellow, Department of Emergency Medicine
> >> UCSF Benioff Children's Hospital Oakland
> >>
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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