Advances in neonatal research demonstrate that newborns experience pain and that controlling pain has short- and long-term benefits for all newborns [ 1-3 ]. Professional bodies and parent groups expect health care providers to prevent infants from experiencing pain [ 4-6 ]. Varying degrees of neonatal discomfort or pain may occur during routine patient care (eg, gavage tube placement, bladder catheterization, or physical examination) [ 7 ], moderately invasive procedures (eg, suctioning, phlebotomy, or peripheral intravenous [IV] access), or more invasive procedures (eg, chest tube placement, circumcision, or central venous access). Pain is most common and intense in infants admitted to the neonatal intensive care unit (NICU). Infants admitted to the NICU frequently experience acute pain from skin-breaking procedures, established pain following surgery, and prolonged (chronic) pain from diseases like necrotizing enterocolitis (NEC) or epidermolysis bullosa. However, despite ongoing efforts, there remains no consistent definition for prolonged or chronic pain in newborn infants [ 8,9 ]. In part due to the lack of consensus regarding the definition of persistent neonatal pain, it appears that only 10 percent of neonates received daily assessments for prolonged continuous pain in the NICU [ 10 ]. (See "Assessment of neonatal pain" .)
In comparison with bag-mask ventilation and use of a SGA, tracheal intubation requires considerably more training and practice and can result in unrecognised oesophageal intubation and increased hands-off time. A bag-mask, a SGA and a tracheal tube are frequently used in the same patient as part of a stepwise approach to airway management but this has not been formally assessed. 56 Patients who remain comatose after initial resuscitation from cardiac arrest will ultimately require tracheal intubation regardless of the airway technique used during cardiac arrest. Anyone attempting tracheal intubation must be well trained and equipped with waveform capnography. Personnel skilled in advanced airway management should attempt laryngoscopy and intubation without stopping chest compressions; a brief pause in chest compressions may be required as the tube is passed through the vocal cords, but this pause should be less than 5 seconds. In the absence of these, use bag-mask ventilation and/or an SGA until appropriately experience and equipped personnel are present.
There is no high quality evidence supporting one particular intervention over another. 2,57 Depending on the circumstances and the skills of the rescuers, use either an advanced airway (tracheal intubation or supraglottic airway (SGA)) or a bag-mask for airway management during CPR. 2,5
With the numerous points we have to choose from for our steroid injections most will find the glutes and lateral (side) deltoid head to be the most comfortable and convenient points of administration. Injection sites such as calves and traps are highly warned against; although in terms of adequate injection sites they are fine, they can produce a fair amount of pain in the individual. No matter where you choose to inject always practice sanitary methods; do not reuse needles or syringes, clean the area thoroughly before injection and always sterilize with alcohol beforehand.