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A 4 year old child presented to our ED with a grossly deformed right fore arm. He was crying incosolably and refused to take any oral analgesia (agitated). He also wasn't aware of his problem and was moving his broken arm. Needless to say this compounded the problem. Obviously the parents were even more distresed.

As he was not taking any analgesia by mouth, I ended up giving him lots of vocal anaesthesia (storytelling!!!) and subsequently 'intra-nasal' diamorph. This also allowed us to splint the arm in plaster. The parents too seemed a bit relieved.

What do members feel about analgesia and departmental procedural sedation of children. Do you use any other agents (like buccal midazolam, IV Ketamine etc)??