Acute pain and ICU Flashcards
(49 cards)
What are some CVS manifestations of pain
tachycardia, hypertension, increased SVR, increased myocardial oxygen consumption
What are some respiratory manifestations of pain
decreased lung volumes, atelectasis, decreased cough, sputum retention, infection, hypoxaemia
What are some GI manifestations of pain
decreased gastric and bowel motility
What are some GU manifestations of pain
urinary retention
what scale can be used to rate pain
simple verbal rating scale
what is the simple verbal rating scale
0 = no pain at rest or on movement 1 = no pain at rest, slightly on movement 2 = intermittent at rest, moderate on movement 3 = continuous at rest, severe on movement
In post-op patients, how do you move along the analgesic ladder
from top to bottom
in palliative patients, how do you move along the analgesic ladder
from bottom to top
what are special circumstances to consider when treating pain
drug dependency
chronic pain
renal failure
if a patient is on methadone, can you give normal opioids?
yes
what type of analgesia should be avoided in patients with renal failure
NSAIDs
what types of analgesia won’t accumulate in those with renal failure
paracetamol
fentanyl
what is the mechanism of action of paracetamol
inhibits prostaglandin synthesis in the CNS
what is the dosing of paracetamol
1g 6 hourly
reduce if <50kg
What is the mechanism of action of NSAIDs
COX-1/2 inhibition
what are contraindications to NSAIDs
peptic ulcer disease / GI bleeding asthma heart failure hypertension renal impairment dehydration pregnancy coagulopathy aspirin/NSAID allergy
how can opioids be administered
PO, SC, IM, IV, intrathecal, epidural
what is the mechanism of action of opioids
agonist of mu receptors
list strong opioids
morphine oxycodone diamorphine fentanyl methadone
list weak opioids
codeine
tramadol
who should you not give tramadol to
epileptics
common side effect of opioids (especially codeine)
constipation
N+V
what is PCA
Patient controlled analgesia
prescribed by Dr, administered by patient
must be prescribed on kardex AND on a separate PCA chart
what is the usual prescription of PCA
1mg bolus morphine with a 5 min lockout
ie 12mg in an hour
