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Hello. Good morning, everybody. We all had a break and have some coffee and ready to go greens. Okay, well, something you know, just being here. But, um, you know everything, okay? Somebody let me know that you can hear me. Okay. So today I am going to talk about analgesia and Children. Truthfully, do be really understanding. Recognize a child and pee. And can we say handle heart that child's and P in I'm becoming about it. And do we always give are all for pain relief So almost like I I'm still learning her deidentified child and peeing. And it's it's something that you learn with time. I guess we'll learn. So this talk today is going to try to talk about these three things. But Brecca guys, the child, um, pee in on then how are we going to measure through their hospital experience in the hospital journey? What is there pain control like to make it as plans on experience for Children has become, I will talk about then different types of pain relief. Okay. Night. Why Isn't hard for us to recognize the child and pee in? Does anyone want to? You put in some thoughts here. Suggestions as to Why, Why, Why you? That's a kiss. Come here. I can't say here, so I use it exactly. Limited communication skills Children are Children can kind of hard to communicate their feelings. Not like adults, but and seeing took when they do have little cues of way that they do communicate it on. It's good not to try on and mess that was week use. I know every child is going to look like this, obviously crying, specially sore. What's worth bearing in mind? No. Every child who looks like this is actually in pain. They could be having. They could be hungry. They could be tired. They could be scared during hospital. Um, they could be annoyed for any number of reasons. Um, maybe that 13, we talk to him about it. They don't always guess when they're sore. That's my point. Here. They should look like this. They can be scared to be quiet. That could be withdrawn. Um, they don't want to be hopeful. They heat hospitals and they don't like doctors generally, but this is where you try to build that trust. If you can identify PM and a child's early doors. There's a good chance you're going to get a child on side on. Parent on site on. They're going to have a bear hospital experience. So even Children here in PM actually could be sleeping. No. Children with tonsillitis are maybe a tightness Media. They don't want to talk to anybody. They're fed up. They just want to curl up in trouble. I'm not sent awake. This chart and thought have it in your mind to consider, um that that not Charley could be sore. Aunt, have you thought about peanut Has a parent for about it again that could be withdrawn. Uh, don't want anyone near than don't want anyone to touch them. All signs actually could be impeding, but not not overtly clear to everybody. Children in peeing could also be playing in the department so they could be running around the department in your room. You're trying to examine them? Like, for example, about little blown boy in the picture there. He could have a pulled elbow, his right arm. But some Children are like resole jersey. All not complain. They'll just keep pushing three. So again, for a child with a pole double, you might not necessarily offer pain relief because the treatment is this far starting. Usually, um, resolves there pain quite instantly so. But there will be a better inflammation swelling right there, too. So it's just the importance off. First of all, regulated a child, a peon. It's a skill. It's an art that takes time. It takes experience. You don't have to have Children to be able to recognize this, but it's just if you can accomplish this, then your chance of all from piano life is going to be much higher. So in the department, good practice. We're all healthcare professionals. We should be documenting what is a child's pain score on arrival, every child growing through the triage department. How we even considered peeing peeing management a peon scores. Children over the age of four usually have the development on the sure it 80 um, be able tests as therapy in um, the fees a scale on the ladder scale have both been researched on proven to be the most followed and reliable off all peeing assessment tools. Eso it's even. There is an element of subjectivity with pain assessment, um, with parental involvement, sprint or anxiety. Um waiting times cried in the department on parents. Maybe Maybe it's over. Score. Their child child of themselves may also over score themselves. But there is that element of clinical just dealt and, uh, clinical know, Hard to just say right. Okay, there's and they're sore. Well, at least I've offered pain relief. Even if you don't think they're sore, they're saying, um, the key thing is getting the pain relief offered given on reassessed. It's It's good practice and we should all be doing it. And we should be showing off how good we are doing it by documenting it other ways. Um, it didn't happen. I've included here the flax skill. The flag skill is a scoring system for babies who you are, No. One community. They won't be able to tell you what their Penis. So just in brief, a child with a clench your prevention the legs drawn up, arched Richard jerking back, crying steadily or different to console are all signs off a child who, maybe in peon there may be other things going on, but, um, they could be needing therapy in addressed. So in summary of the P and scoring systems, the main point is, let's record it early doors when they walk three and triage, um, and show evidence that we are reassessing peeing by recording it before the teeth. So my panel, everyone here should have an idea of hard to treat my opinion with paracetamol or present. No, I haven't put it this late, and I know most of you will be will know this, but majority of the time when I am talking to parents on on discharge, most people don't know hard. Teo, get Parsi Mall at home on. This is crucial because, yes, we can control the peeing in the department bought. This child has to go home and manage the pain at home. So if we can accurately educate parents and how to, uh, hard to administer paracetamol man, there's a good chance this child will not retain. And either on they'll have they'll be comfortable at home. That's the key thing. So Cal Poll is paracetamol that come to get him four times a day. You can take it west either present. It helps with pain and fever. On the dose is 20 mg per kilo loading on day, 15 mg a kilo thereafter, so make this really crystal clear to patients you'd be surprised at. How are you? Many, um, parents are not aware of this. Okay, You're a thin also helps with fever, fever and P in, and it could be taken up to three times daily on. I always tell parents on discharge like to spread out across the day instead of carpeting. Parson, roll on your feet together. Parasite will say. Give the patient Parsi more first thing that a couple of years you're a thin. Couple hours later, the gym or Cal pull. It's just good practice to make sure the child is not having breakthrough pain throughout the day. On the dose they're off your affairs. 10 mg kilo loading, five mil around pretty low thereafter. So sometimes these you can forget these doses, so drop them dying. So next time you're in the department of the child in P in off the street, straight to your thought process. Okay, Again from order. A peon using Parson all neighbor present together is a good show it at the loading dose stages as long as they haven't had paracetamol or preference. On that day, I've been quit it here also that in the over 12 year olds they can be offered coding false feet. But be very resistant about using this. If you're thinking the PM is requiring more attention, I'd be looking at other forms off on allergies. Um, which we'll talk about it here. But with anything you do, you get intervention. You do with a child. You always must make sure that you reassess, reassess. Reassess is great to get pain Relief spot. If a child cell sore, that's no good for them for anybody. For the parents, everyone gets upset. Make sure that you're on top of this Is Christian for China's for European? Um, enter knocks could be used. The holding nature and it's 50% nitrous oxide, 4 50% oxygen. It's fast acting. It's, um, it's really good for Children. As long as they can comply with you and use it on you get all get into their level and chat with them and make them feel See if and trustee. So there's an element of off trust between the doctor and less on day nurse and patient on parents, so we'll talk here by entered a little diamorphine. Some of you may have already administered this before. But, um, the key things here are, um, that all Children who receive introduce a time or should receive 0.2 mils 0.2 mils maximum. Okay, on the concentration will change with the size of the child. So I'll be more concentrated with a bigger child. Just remember, at all times all Children receive 0.3 mils no more, no less, okay? And use a one milk syringe in order to administer the medication. What? This is the the guidelines that are up in the city coverage just for your information. If you get the child's, we it This is all very self explanatory. If your child ways say, for example, 29 kg, we always write dying, that's just important to remember. So if the child is 29 kg, give them the 25 kg at that boy in Australia. Water to dose. Yeah. No. Okay, so when you're administering this medication, there's a video coming up shortly here on how to do it. But just, uh, just to just to say again, this is not gonna be pleasant for the child on it could be scary. This when you come to them with us because all automated at the very top of the syringe. But what is going on? So you need to really shot to them shots The parent, make sure they understand what's going on on play about with the child. You know, Let them fill this range of them, See what? What it is, Onda get their trust on the end when you're ready to do so hot. The child took their head slightly upwards on. Ask them to sniff a senator, You squirt the 0.2 mil up the nostril are the key. Things here are that this is an opiate. So with any of it, you're going to be closely carefully monitoring their GCS on their oxygen saturations on Like any medication like this you most reassess therapy in after 30 minutes are a threat The duration of that time frame that they're in the department. Um, document what? You discard it. Document what you've given. It's crucial of this child is transferred up to you Fracture unit, for example, that they don't get an overdose, especially of a know be it because I can really affect your GCS and then auction levels saturations so document document document. Can't emphasize that off for severe pain. You know. Any ideas? What would I've already flipped across there, but severe PM like fractures, burns significant fingertip injuries are all things that you would be considering to use this medication for. Why you wear their indications where you wouldn't use internasal diamorphine. Does anybody have any ideas? So where? Where? You wouldn't use internasal diamorphine and a child. Any thoughts somebody knows? Like they're it. Become 11 person. Allergies. He is. Thank you, Carl. Anyone else head injuries? Yes. Like Splenda or blocked nose? Um, I guess if they've already had any Oh, b, it's er sedatives recently, then That's another company occasion. You would want to diversity a child. Yet We're just GCS already. Yep. In the muscle trauma. Brilliant. Also, the weight of the child is important. And a child lesson tank, You know, then you'd be looking at or, uh, morphine sulfate solution rather than internasal. Okay, so in summary, that's a brief child about hard to recognize a child. Um, pee in. Remember, Teo, assess their their pee and score on reassess therapy and score to a lot of this child to have a good experience in hospitals. So then the next time come back the bottom not be so happy to see you on. We'll have done our job. Well. So any questions? Oh, Uh huh. Okay. So just wait another. You know, I I I hired Teo make up time working with caramel. You again. Okay, So if you was already told paying a bite and dime or so we're going to just talk for a hard time about nasal diet more for a time and what it would say Is this anything that you can remember? Always remember that you give the same volume into the nostril. Always. No 0.2 mouths. Okay. Never changes. Your dose will change, but the boys have never, ever changes. Okay, so we're gonna tend to this issue or 10 mg off diet. More supplies, your form. Okay, So this is what we're gonna use to pretend this is Your diet works. So the first thing you need to do with the child is your weight of time. So we're going to say child, 21 kg always rhymed. Done. Okay, So for tired is 21 he knows he will go to 20 on your dose. Okay. So avoiding water job going to put into your diet more is going to be one. No. So always, always used 1,000,007 inch. Don't use to meet a spin, John. Just instrumental. Guess that's ocular because you have to be quite creative. I know, right? What? Other meals? So we're going to put a lot of injections. So you want the injection warning time? I am, But it is. I can't put it in, and then just use the end of the needle or whatever, but you're not going to be. It's not legal in anyone to give it a squirt in rhyme. And then you put your needle back and again you will draw up not going to males. Okay, Then you'll take the needle off, and then you want to touch that on to the end off. Strange. Okay, all the time explaining to the parent. And if the child's was not that tired, know what you're doing? So what you're gonna do is you're going to hold one side of the nostril. This goes up into the other side of the nostril. And then what you'll do is if the chance it will not kill. Say, take a big sniff is they take a big sniff? You persist, um, end up to get a note 0.2 mils old intranasal time work into them and not needed. And then, if you need to do it again at a later stage, switch to the other non still. So we'll be still command if you've given intravenous dye, um, or into right now school and literally whatever so that people know exactly what's happened before. I usually do. We practice around like, Oh, give me sniff on the let the child besides this going so it's not too scary, Just practice evaluated. Actually, I hope it.