Dr. Anthony Crocco is back with another RANThony on YouTube. This time he is ranting about paediatric pain management in the emergency department.  This rant was recorded at the Canadian Association of Emergency Physicians (CAEP) meeting last week in Edmonton.

The theme of this year’s CAEP meeting was Lighting the Way. Dr. Crocco was lighting the way through the darkness to improve paediatric pain management in his own unique style.

One thing Dr. Crocco did at the CAEP meeting was interrupt my ten minute talk on oligoanalgesia. He jumps up at the 3:37 mark and give a preview of his pain rant in front of a live audience. This created quiet a stir at the conference and even caught the attention of the security personnel (Julian Rosario-Ng and Jesse Basnak). Check out the YouTube Oligoanalgesia Video of him being a “pain” during my presentation.

Screen Shot 2015-06-05 at 10.58.52 AMDr. Crocco is an evidence based medicine advocate. He has even started his own online project called SketchyEBM. It is a great way to teach the concepts of EBM in a very accessible way. Dr. Crocco presents the EBM concepts but encourages people to “Always draw your own conclusions!”

Pain Rant References:

  1. Cimpello LB et al. Practice patterns of pediatric versus general emergency physicians for pain management of fractures in pediatric patients. Pediatr Emerg Care 2004
  2. Kircher J et al. Pediatric musculoskeletal pain in the emergency department: A medical record review of practice variation. CJEM 2014
  3. Poonai N et al. Opiod analgesia for acute abdominal pain in children: A systematic review and meta-analysis. Acad Emerg Med 2014
  4. Murphy A et al. Intranasal fentanyl for the management of acute pain in children. Cochrane 2014
  5. Harman S et al. Efficacy of pain control with topical lidocaine-epinephprine-tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial. CMAJ 2013
  6. Stevens B et al. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane 2013
  7. Gray L et al. Sucrose and warmth for analgesia in healthy newborns: an RCT. Pediatrics 2015
  8. Hartling L et al. Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial. JAMA Pediatr 2013
  9. Tanabe P et al. The effect of standard care, ibuprofen, and distraction on pain relief and patient satisfaction in children with musculoskeletal trauma. J Emerg Nurs 2002


Codeine Warning:

Health Canada’s review recommends codeine only be used in patients aged 12 and over.


The SGEM has covered some of the challenges of pain management in the emergency department (Drugs in the ER) but never like the ranting paediatric EM super hero Dr. Crocco.

  • SGEM#55: Drugs in My Pocket (Opioids in the Emergency Department)
  • SGEM#60: Nitrous Oxide It’s a Gas, Gas, Gas
  • SGEM#66: King of Pain (Migraine Headaches)
  • SGEM#78: Sunny Days (Pediatric Pain Control)
  • SGEM#87: Let Your Back Bone Slide (Paracetamol for Low-Back Pain)
  • SGEM#111: Comfortably Numb – Low dose Ketamine as Adjunct for ED Pain Control

Dr. Crocco has done a RANThony on Fever Fear and Paediatric Cough Medications. Please let us know if there are other topics you would like him to rant about.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.