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It seems to me that our objectives are all of those which were listed. I
would add amnesia as one goal, not necessarily primary, but nice when it
comes at no expense. We have found that a Child Life worker in the PED,
in concert with judicious use of Versed and Fentanyl, can produce an
experience which leaves a child unafraid, comfortable, and somewhat
empowered for his/her next visit to the PED. I think we really need to
pay attention to the issue of how what we do in the PED affects a childs'
next vist to the PED, the clinic or office, or the school nurse for that
matter.
Still a matter of some judgement as to how significant a laceration
requires the all-out sedation approach with monitoring, recovery, and the
expense that those all entail. Myron Yaster, pain guru here in Pediatric
Anesthesia, has argued fairly convincingly that children need not feel
pain (and wears a button with PAIN surrounded by the interational "no"
symbol). That is a difficult goal to achieve 100% of the time.
 
Allen R. Walker, MD
Pediatric Emergency Medicine
Johns Hopkins