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Evaluación y Tratamiento del Dolor en Urgencias
With Dr. Javier Benito · hosted by Dr. Javier González
Chapter 1 of 7 · Fundamentals
Problem scope
Introduction and scope of the pain management problem
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Institutional protocols should include both pharmacologic and non-pharmacologic pain interventions
Multicenter registry studies show pain documentation in only 25-50% of pediatric emergency cases
Pain assessment should be mandatory at triage and trigger alerts for moderate-to-severe pain
Multidisciplinary education and awareness campaigns are essential for changing institutional culture around pediatric pain
Pain scales are validated in calm environments but perform poorly in the chaotic emergency department setting with high patient volumes
Children under 5 years present the greatest challenge for pain assessment due to inability to verbalize
Both families and healthcare professionals systematically underestimate children's pain compared to the child's self-report
Pain assessment tools require the child to understand and cooperate with the scale, which is often not feasible in acute presentations
Children with chronic pain may appear calm despite severe pain, creating a false impression of adequate control
Environmental factors in emergency departments (noise, lighting, waiting) contribute to inadequate pain management
The literature focuses predominantly on traumatic pain, with less evidence for medical causes of acute pain
Pediatricians prioritize diagnosis over pain relief when children present with non-traumatic complaints
The belief that analgesia will obscure peritoneal signs or complicate surgical evaluation persists among consultants
Adequate analgesia before surgical evaluation does not impair diagnostic accuracy
Intranasal route provides rapid systemic absorption while avoiding first-pass hepatic metabolism
Lipophilic drugs (fentanyl, ketamine) are ideal for intranasal administration due to rapid mucosal absorption
Intranasal fentanyl is non-inferior to IV morphine for moderate-to-severe pain in pediatric studies
Intranasal ketorolac shows efficacy for moderate-to-severe pain as an alternative to IV NSAIDs
Pediatricians systematically under-dose opioids compared to recommended guidelines
In some Latin American countries, opioid access for pediatric emergency patients is severely restricted or unavailable