Diagnosis and clinical management of auricular chondritis in a dog presenting for evaluation of severe pain

AN AUDIT OF THE MANAGEMENT OF ACUTE PAIN IN CHILDREN

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-311535.11 ◽

2016 ◽

Vol 101 (9) ◽

pp. e2.3-e2

Author(s):

Junndeep Sidhu ◽

Neil Tickner

Keyword(s):

Pain Score ◽

Respiratory Depression ◽

Acute Pain ◽

Pain Assessment ◽

Clinical Management ◽

Severe Pain ◽

Opioid Analgesia ◽

Moderate Pain ◽

Strong Opioid ◽

Pain Scores

AimTo evaluate clinical management of acute pain with respect to pain assessment, scoring and timing of analgesia and whether appropriate supportive medicines were prescribed alongside strong opiates. A previous pain audit found dosing of analgesia was appropriate but did not assess clinical management against pain scores. Our paediatric guideline does not currently stipulate guidance on appropriate time frames to administer analgesia and re-assess pain. Standards were developed with a multidisciplinary team to audit against.MethodsData were collected over two weeks on paediatric wards excluding intensive care and day surgery. Inclusion criteria: Pain score of ≥1 during admission, or clear documentation of pain prior to ward admission, and analgesia prescribed for the indication of pain relief. Pain assessment was audited based on recorded pain scores on observation charts. Analgesia prescribed and administered was audited from drug charts. Audit standards:(1) Following a pain score of ≥1 (out of 3), subsequent dosing and assessment of pain scores must be achieved in 80% of patients as follows:(a) Severe/worst pain (score 3): Should receive appropriate analgesia within 20 minutes of assessment and pain re-evaluated within 5-minute intervals for intravenous and intranasal route or within 30 minutes of receiving oral analgesia.(b) Mild/moderate pain (score 1–2): Should receive appropriate analgesia within 30 minutes of assessment and pain re-evaluated within 60 minutes of receiving analgesia.(2) 80% of patients prescribed regular analgesia should have their pain score assessed at least 4-hourly.(3) 90% of patients prescribed strong opioid analgesia should be co-prescribed naloxone prn for respiratory depression and pruritus/urinary retention.ResultsTwenty-five patients were audited. In total there were 59 severe pain scores and 92 mild/moderate. Observation charts allowed for documentation of pain scores at 15-minute intervals but only hourly recordings were observed throughout the audit period. 58% (34/59) and 30% (28/92) of pain scores indicating severe or mild/moderate pain respectively received analgesia in the same hour the pain score was recorded. In total there were 71 analgesia administrations for severe pain and 92 for mild/moderate pain. 52% (37/71) and 34% (31/92) of analgesia administrations after severe or mild/moderate pain scores respectively had a pain score re-assessed within 60 minutes.Eighteen patients were prescribed regular analgesia of whom 15 (83%) had pain assessed a minimum of every 4 hrs. Eleven patients were prescribed strong opioid analgesia, 45% of whom were not prescribed any naloxone, 27% had naloxone fully prescribed (pruritus and respiratory depression), and 27% had naloxone prescribed for respiratory depression alone.ConclusionDespite lack of guidance around timing of pain assessment and administration of drugs, pain scores were being recorded regularly and acted upon, although not within a structured time frame. Observation charts allowed for assessment of pain scores at 15-minute intervals but only ‘on the hour’ documentation were observed. Specific guidance around timing of analgesia administration and assessment will be introduced to the revised guideline with medical and nurse training sessions to standardise practice and improve management of pain, in addition to safe prescribing of opiates.

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Assessing the Use of Age-Equivalent Scores in Clinical Management

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.2301.06 ◽

1992 ◽

Vol 23 (1) ◽

pp. 6-8 ◽

Cited By ~ 7

Author(s):

Carol W. Lawrence

Keyword(s):

Case Management ◽

Clinical Management ◽

Management Decisions ◽

Language Deficits

Speech-language evaluation reports from many institutions present age-equivalent scores as the evidence for speech-language deficits. Yet, the value and interpretation of this measurement criterion requires clinical scrutiny. This article reviews the concept and derivation of age-equivalent scores and presents arguments against their use in case management decisions.

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Structural Aspects of Phonological Development

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1901.05 ◽

1988 ◽

Vol 19 (1) ◽

pp. 5-16 ◽

Cited By ~ 5

Author(s):

Karen E. Pollock ◽

Richard G. Schwartz

Keyword(s):

Clinical Management ◽

Structural Complexity ◽

Strong Preference ◽

Phonological Development ◽

Structural Position ◽

Phonological Disorders ◽

Syllabic Structure ◽

The Relationship ◽

Structural Aspects ◽

Target Words

The relationship between syllabic structure and segmental development was examined longitudinally in a child with a severe phonological disorder. Six speech samples were collected over a 4-year period (3:5 to 7:3). Analyses revealed gradual increases in the complexity and diversity of the syllable structures produced, and positional preferences for sounds within these forms. With a strong preference for [d] and [n] at the beginning of syllables, other consonants appeared first at the end of syllables. Implications for clinical management of phonological disorders include the need to consider both structural position and structural complexity in assessing segmental skills and in choosing target words for intervention.

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