Pediatric emergency medicine trisk 4315 4315

children are generally in the visual distractor group, something they can see
and/or grasp will provide the highest likelihood of successful distraction.
During medical and trauma resuscitation or other acutely life-threatening
situations, ED staff should strive to provide a professional staff member to
support the family and to address questions in an ongoing fashion. This will allow
the medical team to concentrate on the acute care needs of the child while still
supporting the family through this difficult situation.
For patients requiring pharmacologic sedation, caregivers should be informed
about expected responses based on the patient’s developmental level, potential
effects of sedation, the purpose of monitoring equipment that will be attached to
their child, and any anticipated discomfort subsequent to the procedure. The
assurance that use of these medications can increase safety and may minimize
repeated discomfort should be emphasized.
The medical team should consider whether the ED is the appropriate venue in
which to perform the procedure. Collaborative discussion with the care team prior
to presenting options to the family may be beneficial. Points to consider include
the developmental assessment of the child, the anticipated length of the
procedure, positioning and management of patient movement, and the need for
pharmacologic interventions. Lengthy procedures or a procedure in a patient with
a significant inability to cope may deplete resources and might be more safely
performed in the operating suite. Consequences and complications of the
procedure should be anticipated prior to commencing, with mitigation plans in
place as needed, particularly in medically complicated or high-risk patients. Aside
from procedures necessary to address immediately life-threatening emergencies,
assent and support for the procedure should be sought from the child and parents
beforehand. An informative, efficient discussion of risks, benefits, and
alternatives almost always reassures the parents of the need for the procedure.
Written consent may not be necessary for simple procedures, but standards should
be explicitly defined by local ED clinical leadership and hospital policies around
which procedures require written consent, what defines an emergency during
which written consent can be bypassed, and under what conditions a minor

should also assent.
Finally, prior to initiating a procedure on any patient the use of a team time-out
before starting should be promoted as part of the ED safety culture. Use of a
checklist during the time-out can ensure that the correct procedure is being
performed on the correct patient at the correct anatomic location and that
adequate supplies are available for the procedure.

POSITIONING AND RESTRAINTS