12.06.2008

Normal Saline Analgesia

I've been working on the floors of a peds hospital for the past month and I finished up my last call the Saturday before Thanksgiving. I had to cover a new admit with the working diagnosis of "Chest Pain" just admitted last night. Seemed like a strange symptom in a tween, but I'm pretty much open to anything after a few months at the major referral center.

Generally, I like to approach these new patients with an open mind and go through my working differential a kind of slowly since I'm still not the brightest crayon in the box. Her symptoms were refractory to a week of antacids/PPI's and had NO identifiable triggers or patterns. Kid had a normal cardiac workup, normal pulmonary work up, clear films of the chest and abdomen, nothing out of the ordinary on labs. So I go out onto the floors to start the day and I hear what sounds like crying coming from her room...great.


Mom comes running out to ask for pain meds. So I eyeball her...and she looks like she's a little uncomfortable, but not in too much distress. She's able to answer my questions clearly through her distress and "8/10" pain. I get the story from mom and it seems like the kid has these paroxisms of stabbing, non-specifically localizable chest pain for about a week. Kid's not in any distress, so I walk away to see the other 10 patients I was covering. Motrin doesn't touch it. Tylenol #3 puts the kid in a comfortable place...problem solved.

So I sit down to write some notes about and about an hour later I hear screaming coming from the room again and mom comes out looking distressed. I stroll on over to check on the kid...10/10 pain, inconsolable, stabbing pain everywhere in her chest. But she still answers my questions and is distractable. Resident writes for some morphine and the nurse goes in a few seconds later to flush the IV and get some fluids running before she pulls the drugs out of the Pyxis.

On the way back over to the room, the nurse notices that it's unusually quiet on that side of the unit...so she palms the morphine while asking the kid how she's feeling. She feels great now, 2/10 pain. Much better!!! I'll file the normal saline analgesia trick away for the finicky attention seekers later in my career.

The difference between kids and adults when they fake:
Adults seek the rush they feel from morphine hitting their neurons,
Kids seek the rush of everyone's attention falling on them for a brief moment

Just an interesting case that I wanted to share.

2 comments:

sophistikatedsmiley said...

I'm one of the new people who started reading your blog. I find this post really something I could relate to because on my pediatric clinical rotation, I came across a kid who did the same thing--at first I took the kid's cries and complains totally seriously but then I realized that he was just an attention-seeker. I realized this the same way with the IV flush in hand. The kid felt miraculously better after a flush. Love it

Resident Anesthesiologist Guy (RAG) said...

Had a kid like that once - had learned behaviors from their parents and would ask for pain meds to be pushed fast because it felt good. Scary in someone not even 10.