preliminary program

IMPORTANT: All Workshops should be case-based, i.e. authentic clinical cases and scenario’s are used for interactive discussion. Use of slides should be limited to  present cases and short summaries of essential learning points. Please do not give (mini)lectures during the workshop.

DAY 1 Workshops

Workshop 1: ‘Lying still’

• Non-pharmacological strategies to help children lying still during imaging procedures (e.g. MRI scanning)
• Marjolein Verly MSc, PhD (Leuven University; Departments of Radiology and Neurosciences) developed an interactive tool to help children lying still during MRI scanning. Her Cosmoprotocol turned out to be very successful and resulted in a substantial decrease of need for sedation.

Workshop 2: ‘No more Tears’

• Many claim offering a patient-centered service when dealing with distressing procedures in children. But how much choice do we really grant to children and their parents? And how can we make patients/parents competent for making appropriate choices that contribute to optimal procedural perceptions and experiences?
• Anna Taddio developed with her team a method for active knowledge translation so that children/parents themselves can learn which methods work best for them. From the University of Toronto Website: “In the past, we’ve burdened the health-care provider with everything,” says Taddio. “But I think it’s better to show the kids and then they can choose how to best cope. In the end, Taddio says it’s all about medical community acknowledging the existence of pain and working with patients to reduce its impact during injections and other procedures. Treating pain has many benefits,” she says. “It not only prevents unnecessary suffering, it ensures we are delivering the best care possible, improves everyone’s satisfaction with the experience, and improves health because people are more likely to participate in positive health behaviours like getting vaccinated and going to a doctor to get a blood test to look for high cholesterol and these sorts of things.”

Workshop 3: ‘Not just a Poke’

• Correct use of topical anesthetics (location, timing, tips – tricks, logistical challenges)
• Misconceptions (e.g. emla generates more failure of IV access)
• Other techniques (cooling, J-tip, subcutaneous infiltration of buffered lidocaine with a 30G needle, Buzzy,...): evidence, experiences, practices...

Workshop 4: ‘Stitches and Fractures’.

• How to create an ouchless ER
• Suggested procedures to discuss/to use for discussion: Wound care and suturing; Non-complex forearm fracture; Abscess drainage
• Points for discussion: patient approach; optimal local/topical techniques; when to use sedation? Which sedation (important point to discuss: indications versus limitations of nitrous oxide)
• IMPORTANT: Is Fentanyl (IN or IV) on its own sufficiently effective for fracture reduction or similar painful procedures?
• Key questions a professional should ask him/herself before starting procedures: (1) Is the child in pain before (i.e. in need for acute pain management). (2) Environmental setting. (3) Adaptive distraction possible? (4) How painful is the procedure anticipated by you, the family/child? (4) Use of topical analgesics. (5) Most optimal additional sedative (anxiolysis or deep sedation?)
• Mark Roback (MD; Pediatric Emergency Specialist; Colorado; USA) has published extensively on Pediatric Procedural sedation in the ER setting; Silvia Bressan (MD; Pediatric Emergency Specialist; Padova; Italy) is intensively involved in Procedural Sedation&Analgesia Services and Training; Julia Hoeffe (MD; Pediatric Emergency Specialist; Bern; Switserland) published on Procedural Sedation&Analgesia including Nitrous Oxide sedation.

Workshop 5: ‘Changing the Talk of Town’.

• Changing the way we talk as professionals with patients and with eachother
• Which words/sentences may harm and which kind of talk might enhance trust and feelings of comfort?
• Stéphanie Gollut (MD; Pediatrician; Geneva; Switzerland) is a specialist in Pediatric hypnotherapy and was involved in a hospital-wide project intended to change the way of communication; Cyril Sahyoun (MD; Pediatric Emergency Specialist; Geneva; Switzerland)

Workshop 6: The Traumatized Child

• Managing anticipatory Anxiety; Cognitive Behavioral Strategies; Desensitization
• What does ‘trauma’ mean
• Iatrogenic Post-Traumatic Stress Disorder; EMDR therapy
• Inge de Vlieger (MSc; Psychologist; Amsterdam; NL) is an expert in EMDR therapy

DAY 2 Workshops

Workshop 7: Language – Suggestion – Hypnosis

• Examples and exercises of positive suggestions by using proper wording
• Fundamentals of Hypnosis
• Practical Examples of Simple Scripts

Workshop 8: Case-Based exercises on best sedation strategies for common Pediatric Procedures

• IV acces
• Nasogastric tubes
• Urinary Catheters

Workshop 9: Capnography – practical exercises

• Practical applications of capnography during deep sedation
• Typical curves for normal ventilation, types of hypoventilation, partial and total airway obstruction,...
• Meaning of capnometry

Workshop 10: Sedation for radiologic imaging

• Which children will need sedation? Which may benefit from non-pharmacology [Refer to Workshop 1 – Day 1]?
• Best practice for < 3-6 months; 6m-5 yrs; > 5 yrs
• Propofol? Dexmedetomidine (IV? IN? Doses?)
• Patient-centered sedation care on a radiology department. What is needed?

Workshop 11: Sedation in special needs children and children with autism spectrum disorder

• For example: autism spectrum disorder, severe anxiety, hyperactivity, mental retardation,...
• How to involve parents/caretakers?
• Which drugs might be more optimal?

Workshop 12: Setting up a sedation Service in your Hospital

• Which conditions are needed (evidence-based protocols; transparency; inter-disciplinary collaboration; consistent; Patient-Centered)
• Introducing TROOPS