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Luther is given pain relief

Ok so if you grab the Entonox and we’ll get some pain relief sorted. OK. Luther can I have another look at this arm?
I won’t press too hard. Ok. Let me just have a feel. Ouch!
Ok so he’s got pain and tenderness and some swelling over the left elbow. He’s got a good radial pulse. Circulation is good. His hands nice and warm. Good. So what we’re going to do, we’re going to get him some, has he had any Calpol today? So we get him some Calpol. So we will also give him some of this gas. He will inhale it and take some of the pain away.
How old is he? He’s six. And he’s got no allergies or anything? No.
Right then Luther. This is just some Calpol, OK? Just pop it in your mouth and squeeze it in ok? Do you want me to help you do it?
That’s perfect, thank you.
Ok so can you hold this with your good hand? Ok, pop that in your mouth. Like a straw… and then you breathe in, that’s it and out. And then breathe all the way out. Nice and slow. Ok then, well seeing as he is holding his arm quite comfortably like that, we should probably put it in a high arm sling for him just to take off some of the weight. Yes. Cool. So he’s obviously got an injury to his elbow. Not too sure what’s happening at the moment. We’re going to have to pop him into the hospital. Head injury wise, he’s just got a very small lump on his head not too concerned about that.
So just going to pop his arm into a sling. Ok. Luther we’re  going to pop this bandage around your arm ok?
Ok, if you just keep breathing on that gas. I’m just going slide this underneath your arm. Ok. That’s it. Nice and gentle. You’re doing really well mate.
Let me tie this behind your neck.
Is that nice and comfortable?

At the very outset, confidence and good communication are important. Anxiety and fear can sometimes promote hysteria. Kind but firm language can help de-escalate fraught situations (remember parents and teachers may be causing unnecessary panic!).

Entonox (laughing gas/gas & air) is an extremely useful agent in this situation. It provides both analgesia and anxiolysis (chills them out…) as they need to concentrate on controlling their breathing.

Immobilisation will stabilise a fracture and reduce discomfort from unnecessary movement. There are bespoke devices to aid immobilisation but simple slings or splinting can also be very effective.

Give oral analgesia where possible; it is useful to consider give paracetamol and an NSAID (i.e. ibuprofen) early. These drugs take time to have an effect so if you wait for the hospital to prescribe the the child will be in discomfort for longer than necessary.

Now that Luther has had a sling applied to his sore elbow, what things do you need to keep an eye on?

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Emergency and Urgent Care for Children: a Survival Guide

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