LIN Session - The Child Whisperer

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Sean G., M.D. -

Ok I agree with most of this stuff...but you are giving a mixed message here...and about one of my pet peeves...so had to comment. "Tell the child the iv is a straw" "but dont be dishonest with the child"...."You can even show the child the iv(without the needle of course) so the child can see its like a straw"......HELLO????? Are you guys placing this "straw" w/o a needle inside it? Isnt that lying to the child when you play a magic trick and make the needle disappear? What do u say to that child when that "straw" feels like someone sticking a damn NEEDLE in their vein? I get the straw thing...but as you guys said in one part...you should NOT lie to a child. Kids are not that stupid, if you tell them its just a straw and then the nurse pokes him with said straw for 3 minutes and it sure feels like a damn needle you have lied to that child. I bring this up because this IS a difficult situation. I try to be as honest as possible. I HATE when some well meaning adult tells the kid it "just hurts for a split second" just before I do a digital block. So this is a real point. What do u tell the kid? To me hiding the needle, then conveniently leaving the room for the nurse to re introduce said needle to straw is not an answer. I just try honesty. If the kid is getting an iv I tell them, it will hurt, but we will make that go as quickly as possible and we will not do anything that the child cant handle. We will get rid of the needle as fast as we can.....Then a reassuring parent or staff member, and some good ol Elmo and I think u have something to work with. Pretending there is no needle is not legit IMO.

Brad O. -

I didn't know you are on EM:RAP Doc??? well here we are!

Sean G., M.D. -

That’s awesome u are getting EMRAP ! I wish more nurses did! I assume you are Brad I knew from Florence?

Sean G., M.D. -

the "Elmo Calls" app was awesome! I had a 2 year old with a full thickness lac of forehead, with a galeal lac. Mom tells me she was here several months ago with a smaller lac and it took "four grown men to hold her down and she screamed the whole time". I assured her that would not be repeated. I asked her if she had ever face timed or skyped...and she had...with her dad. So I said would u like to face time with Elmo? She was very intrigued. I gave her a brief example. I placed Let in the wound for twenty minutes. Placed 4cc 2% lidocaine in 4 separate TB 1cc syringes and 30 ga needle. When it was time to add the lido I told her it might sting just a little...but I knew she could handle it...and I wanted her to talk to Elmo. She got the hang of calling him no problem. The entire time I slowly injected the 4cc of lido she was fixated on Elmo....rarely she made a sigh of pain and I reminded her it will never be worse than that. No one was holding her down. It was just me and her and Elmo.. Got all the lido in and she didn't flinch with the galea repair, or the skin closure. Not at all. Mom was floored. She was so happy she could not believe it....4 grown men or Elmo? i'm riding with Elmo every time! Thnks! And p.s. I am a big guy with a tin of tattoos...most people think I am security! The little girl loved me! Thanks r Lin!
I will say taking the time to divide your lido into 1 cc syringes is huge. The 3, 5 and 10 cc syringes impart a lot more pressure to the infiltration and therefore pain. The icc syringe is smooth as silk. Takes about 2 minutes more and 10 cents more in supplies.

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