title: Extensive lower limb injuries in a child complicated by complex pain management and profound anemia.
abstract: We describe a case of severe pain associated with extensive lower limb injures in a 5-year old, complicated by profound anemia in a Jehovah's Witness family. The study was carried out in a pediatric intensive care unit of a tertiary level university hospital. The patient was 5-year-old girl, with multiple open fractures and extensive soft tissue loss on her left foot and ankle due to a lawnmower injury leading to severe pain and profound anemia with management of the latter complicated by family beliefs. The interventions given were multi-modal pain management and treatment of severe anemia with avoidance of transfusion. A drop in hemoglobin from 11.6 g.dl(-1) at admission to a nadir of 4.3 g.dl(-1) on day 7 was observed. Effective pain control was achieved with nurse- and then patient-controlled analgesia plus adjuncts. Effective pain management and control of anxiety can be achieved by a multi-modal approach in young children. Profound anemia was treated without transfusion and without compromise of tissue healing.
authors.affiliation: Departments of Pediatric Anesthesia, Montreal Childrens' Hospital and McGill University, Montreal, QC, Canada. roula.cacolyris@muhc.mcgill.ca
authors.forename: Giuliana
authors.initials: G
authors.lastname: Rizzo
authors.forename: Marinella
authors.initials: M
authors.lastname: Astuto
authors.forename: Davinia E
authors.initials: DE
authors.lastname: Withington
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000740:Anemia / Q000209:etiology / Q000628:therapy; D002675:Child, Preschool; D005260:Female; D005597:Fractures, Open / Q000150:complications*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D033221:Jehovah's Witnesses; D007869:Leg Injuries / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins