Continuing Professional Development: Pain management in children in the pre-hospital environment

After completing this module, the paramedic will be able to:

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It's a cold and wet Saturday afternoon when you are dispatched to a 9-year-old male with a suspected lower limb injury. The incident location is a local football field. On your arrival, you are greeted by the coach and a few other parents who inform you that he has twisted his ankle badly. Owing to the weather conditions, you take the stretcher, scoop, Entonox®, vacuum splint and a few blankets onto the pitch in anticipation of moving to the ambulance. You find the patient in the supine position with his hands covering his face, screaming. The history of the complaint involves the patient entering a tackle with another player; he heard a ‘crack’ and felt a sudden surge of pain to his right ankle. Unable to weight-bear, he remained on the floor. You undertake a quick primary survey and then expose and examine the ankle which is swollen and painful to touch. The pedal pulse is present; there are no breaks to the skin; and distal movement and sensation are intact. You suspect a fractured distal tibia/fibular on account of the significant swelling. A pain score is obtained (10/10) using the Numeric Pain Rating Scale (NPRS). You make the decision to administer Entonox, apply a vacuum splint, scoop onto the stretcher and move onto the back of the ambulance to escape the adverse weather conditions.