Procedural pain: topical anaesthesia, preparation, distraction and non-pharmacological support — branching viva

Emergency department: a 6-month-old alert infant needs a venepuncture and cannulation, the mother is present and anxious, and the team has about 70 minutes. The examiner asks how you would assess and plan the comfort bundle, which topical agent and timing you would choose, how you would dose and time oral sucrose, and how you would position the child — then branches to a 3-week-old neonate given EMLA who becomes cyanosed, to the mechanism and treatment of methaemoglobinaemia, and finally to the needle-phobic adolescent and the limits of the bundle.