Pain

Question 1

What types of broken long bones are there?

Answer 1

Straight across, angled, twisted, crushed, pieces, bent (in kids), or near growth plates (in kids).

Question 2

How do you check blood flow and nerves in a broken arm or leg?

Answer 2

Compare both sides. Ask if they can feel and move it. Check color, warmth, pulses, and how fast blood returns after pressing skin.

Question 3

When do you need an X-ray for an ankle injury? (Ottawa Rules)

Answer 3

If there’s ankle pain AND:
* Tenderness on the back of the ankle bones
* Can’t walk 4 steps right after injury or in hospital.

Question 4

What warning signs after putting a kneecap back in place need help?

Answer 4

If leg feels numb, very painful, swollen, can’t walk, or knee keeps popping out again - get help fast.

Question 5

How do you pop a dislocated kneecap back in?

Answer 5

Help the person lie down. Gently straighten the leg. Push the kneecap toward the middle of the leg. You may feel a small ‘pop’. Check feeling and movement after.

Question 6

What veins are preferred for IV insertion?

Answer 6

Cephalic, basilic, dorsal metacarpal veins

These veins are visible and straight, making them suitable for IV insertion.

Question 7

List the necessary prep items for IV insertion.

Answer 7

• Alcohol swab
• Tourniquet
• Flush
• Cannula
• Tegaderm
• Sharps bin

These items are essential for a safe and effective IV insertion.

Question 8

What is the correct angle for IV insertion?

Answer 8

Bevel up

Inserting the cannula bevel up helps ensure proper entry into the vein.

Question 9

What should confirm vein entry during IV insertion?

Answer 9

Flashback

A flashback of blood confirms that the needle has entered the vein.

Question 10

What areas should be avoided for IV insertion?

Answer 10

• Flexion areas
• Bifurcated veins
• Damaged skin

These areas pose a higher risk for complications during IV insertion.

Question 11

What is the primary indication for IO insertion?

Answer 11

Emergency access when IV is not achievable

This includes situations like shock or cardiac arrest.

Question 12

List the sites suitable for IO insertion.

Answer 12

• Proximal tibia
• Distal femur
• Proximal humerus
• Sternum

These sites provide access to the vascular system when IV access is not possible.

Question 13

What technique is used to insert an IO needle?

Answer 13

Drill needle with pressure and rotation

This technique helps ensure proper placement of the IO needle.

Question 14

What should be done after confirming IO placement?

Answer 14

Flush vigorously, secure and monitor

Vigorous flushing may cause pain but is necessary to ensure patency.

Question 15

When should IO access be used instead of IV access?

Answer 15

When IV is delayed or unsuccessful

This is particularly critical in emergencies like cardiac arrest or shock.

Question 16

What factors should be considered when deciding between IV and IO access?

Answer 16

• Urgency
• Patient condition
• Expected need for rapid vascular access

These factors help determine the most appropriate access method.

Question 17

What is a key reason for early IV or IO access?

Answer 17

Enables prompt drug/fluid administration

Early access can be critical in emergency situations.

Question 18

Why should the need for IV or IO access be reassessed regularly?

Answer 18

To avoid unnecessary insertion ‘just in case’

Regular reassessment helps ensure patient safety and comfort.

Question 19

What considerations should be made regarding patient comfort?

Answer 19

Risk of complications and benefit of access

Balancing comfort with the need for vascular access is crucial in patient care.

Question 20

What are the common causes of low back pain?

Answer 20

• Muscle strain/sprain
• Herniated disc
• Spinal stenosis
• Fractures
• Infections (e.g. discitis, abscess)
• Tumours/malignancy
• Inflammatory arthritis (e.g. Ankylosing Spondylitis)
• Non-spinal: AAA, renal colic, pancreatitis, PID

AAA stands for Abdominal Aortic Aneurysm, and PID stands for Pelvic Inflammatory Disease.

Question 21

What red flag signs suggest serious pathology in low back pain?

Answer 21

• History of cancer
• Unexplained weight loss
• Severe night pain
• Age <16 or >50
• Major trauma
• IV drug use
• Fever/infection
• Immunosuppression
• Saddle anaesthesia
• Bladder/bowel dysfunction
• Neurological deficit

Red flags indicate a need for further investigation to rule out serious underlying conditions.

Question 22

What are ‘yellow flags’ in low back pain?

Answer 22

• Psychosocial risk factors that may prolong recovery, such as:
  
  • Fear of movement
  • Depression or anxiety
  • Job dissatisfaction
  • Poor social support
  • Ongoing rest or sick behaviour
  • Insurance issues

Yellow flags can hinder recovery and may require targeted interventions.

Question 23

How is non-traumatic low back pain typically assessed?

Answer 23

• History including red/yellow flags, pain details, psychosocial context
• Physical exam: mobility, neuro check, spine exam
• Pain score 0-10
• Consider cauda equina symptoms- Rule out serious pathology first

Cauda equina syndrome is a serious condition requiring immediate medical attention.

Question 24

What is the appropriate pharmacological treatment for mild to moderate back pain?

Answer 24

• Mild: Paracetamol, NSAIDs (e.g. ibuprofen)
• Moderate: Add oxycodone if needed (5 mg q4-6h), plus laxatives
• Avoid routine benzodiazepines or long-term opioids

NSAIDs are non-steroidal anti-inflammatory drugs.

Question 25

What is the best practice non-pharmacological treatment for acute low back pain?

Answer 25

- Early mobilisation - Physiotherapy referral - Exercise programs - Heat application - Education and reassurance - Manual therapy (after 48h) ## Footnote Non-pharmacological treatments can be effective in managing acute low back pain.

Question 26

How should paramedics manage low acuity non-traumatic back pain?

Answer 26

- Provide basic analgesia - Encourage movement - Avoid unnecessary transport or imaging- Refer to community services if available - Educate patients when possible ## Footnote Paramedics should focus on stabilizing the patient and providing appropriate care.

Question 27

What is the disposition plan for low back pain in the ED?

Answer 27

- Red flag present: urgent senior or specialist review - Radiculopathy: refer to physio or GP - Non-specific pain: analgesia, movement, physiotherapy - Non-spinal causes: treat accordingly - Provide clear discharge advice ## Footnote Disposition plans ensure that patients receive appropriate follow-up care.

Question 28

What are the three layers of the meninges?

Answer 28

1. Dura mater (outer, tough) 2. Arachnoid mater (web-like) 3. Pia mater (inner, delicate) ## Footnote The meninges protect the brain and spinal cord.

Question 29

What does the CSF do?

Answer 29

Cushions the brain, delivers nutrients, removes waste, and regulates pressure ## Footnote CSF stands for cerebrospinal fluid.

Question 30

What are the three main parts of the brain?

Answer 30

Cerebrum (thinking, motor) Cerebellum (balance) Brainstem (vital functions like HR and breathing) ## Footnote HR stands for heart rate.

Question 31

What is the function of the frontal lobe?

Answer 31

Controls movement, judgment, and planning ## Footnote The frontal lobe is crucial for executive functions.

Question 32

Which lobe processes body sensations?

Answer 32

Parietal lobe ## Footnote The parietal lobe integrates sensory information.

Question 33

Which cranial nerve controls smell?

Answer 33

Olfactory nerve (Cranial Nerve I) ## Footnote This nerve is responsible for the sense of smell.

Question 34

What is the Monro-Kellie Doctrine?

Answer 34

The skull has fixed volume: brain tissue, blood, and CSF must stay in balance to maintain normal pressure ## Footnote This principle is important in understanding intracranial pressure.

Question 35

What causes increased intracranial pressure (ICP)?

Answer 35

Brain swelling, more blood flow, or too much CSF (e.g. tumour, injury, hydrocephalus) ## Footnote Hydrocephalus is a condition characterized by an accumulation of CSF.

Question 36

What does the AEEIOU-TIPS mnemonic help with?

Answer 36

Identifying causes of altered consciousness: Alcohol, Epilepsy, Endocrine, Insulin, Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke ## Footnote This mnemonic aids in differential diagnosis.

Question 37

What is cerebral perfusion pressure (CPP)?

Answer 37

CPP = MAP - ICP. It shows how well the brain is getting blood and oxygen ## Footnote MAP stands for mean arterial pressure.

Question 38

What are the three layers of the meninges?

Answer 38

1. Dura mater (outer, tough) 2. Arachnoid mater (web-like) 3. Pia mater (inner, delicate) ## Footnote The meninges protect the brain and spinal cord.

Question 39

What does the CSF do?

Answer 39

Cushions the brain, delivers nutrients, removes waste, and regulates pressure ## Footnote CSF stands for cerebrospinal fluid.

Question 40

What are the three main parts of the brain?

Answer 40

Cerebrum (thinking, motor) Cerebellum (balance) Brainstem (vital functions like HR and breathing) ## Footnote HR stands for heart rate.

Question 41

What is the function of the frontal lobe?

Answer 41

Controls movement, judgment, and planning ## Footnote The frontal lobe is crucial for executive functions.

Question 42

Which lobe processes body sensations?

Answer 42

Parietal lobe ## Footnote The parietal lobe integrates sensory information.

Question 43

Which cranial nerve controls smell?

Answer 43

Olfactory nerve (Cranial Nerve I) ## Footnote This nerve is responsible for the sense of smell.

Question 44

What is the Monro-Kellie Doctrine?

Answer 44

The skull has fixed volume: brain tissue, blood, and CSF must stay in balance to maintain normal pressure ## Footnote This principle is important in understanding intracranial pressure.

Question 45

What causes increased intracranial pressure (ICP)?

Answer 45

Brain swelling, more blood flow, or too much CSF (e.g. tumour, injury, hydrocephalus) ## Footnote Hydrocephalus is a condition characterized by an accumulation of CSF.

Question 46

What does the AEEIOU-TIPS mnemonic help with?

Answer 46

Identifying causes of altered consciousness: Alcohol, Epilepsy, Endocrine, Insulin, Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke ## Footnote This mnemonic aids in differential diagnosis.

Question 47

What is cerebral perfusion pressure (CPP)?

Answer 47

CPP = MAP - ICP. It shows how well the brain is getting blood and oxygen ## Footnote MAP stands for mean arterial pressure.

Question 48

What is the difference between pain and nociception?

Answer 48

Pain is a subjective experience involving perception and emotions. Nociception is the objective detection of harmful stimuli by nociceptors. ## Footnote Understanding the distinction is crucial for pain management strategies.

Question 49

What are the characteristics of fast pain?

Answer 49

Fast pain is sharp, highly localised, and rapidly perceived. It is transmitted by A-delta fibres. ## Footnote Fast pain is often the first type of pain experienced during an injury.

Question 50

What are the characteristics of slow pain?

Answer 50

Slow pain is dull, diffuse, and hard to localise. It includes aching and throbbing and is transmitted by C-fibres. ## Footnote Slow pain typically follows fast pain.

Question 51

What is chronic pain?

Answer 51

Chronic pain lasts longer than 6 months and can persist even after tissue healing, often due to central sensitisation. ## Footnote It can significantly affect quality of life and requires different management approaches.

Question 52

What is neuropathic pain?

Answer 52

Neuropathic pain arises from nerve damage or disease, such as diabetic neuropathy or shingles. ## Footnote This type of pain may require specific treatment strategies.

Question 53

What is inflammatory pain?

Answer 53

Pain that occurs in the presence of inflammation, often due to release of local mediators that sensitize nociceptors. ## Footnote Inflammatory pain plays a key role in the body's response to injury.

Question 54

How does the brain perceive the location and type of pain?

Answer 54

The spatial and temporal patterns of nociceptive signals from the dorsal horn are mirrored in the thalamus, allowing the brain to determine location and quality. ## Footnote This process is essential for appropriate pain response.

Question 55

What is referred pain and how does it happen?

Answer 55

Pain perceived at a location different from the injury site due to shared spinal pathways (convergence of sensory input). ## Footnote This phenomenon can complicate diagnosis and treatment.

Question 56

What is the role of descending inhibitory pathways?

Answer 56

They reduce pain signal transmission in the dorsal horn, allowing the brain to prioritize survival-related activities. ## Footnote These pathways are crucial for pain modulation.

Question 57

What is central sensitisation?

Answer 57

A condition where the CNS becomes hypersensitive to pain signals, contributing to chronic pain. ## Footnote It can lead to exaggerated responses to stimuli.

Question 58

How does transduction work in pain physiology?

Answer 58

Transduction is the conversion of harmful stimuli into electrical signals by nociceptors. ## Footnote This process is the first step in pain perception.

Question 59

What is modulation in pain processing?

Answer 59

Modulation alters pain signals during transmission, either enhancing or inhibiting them. ## Footnote It is a key aspect of how pain is experienced.

Question 60

What is the Gate Control Theory of pain?

Answer 60

Pain signals are modulated in the spinal cord by 'gates' that can be closed by other sensory input, reducing pain perception. ## Footnote This theory explains why rubbing a painful area can lessen the pain.

Question 61

What are the three components of Melzack's Multidimensional Model?

Answer 61

1. Sensory-discriminative, 2. Motivational-affective, 3. Cognitive-evaluative. ## Footnote This model highlights the complexity of the pain experience.

Question 62

Why is pain described as subjective?

Answer 62

Because it is influenced by individual perception, context, emotion, and past experiences, not just physical stimuli. ## Footnote This subjectivity emphasizes the importance of personalized pain management.