Pain management Flashcards
(27 cards)
What is the MC presenting symptoms in the ER?
Pain
How do you measure pain?
Pain scale (1-10) or Wong-Baker Faces
What makes pain control hard?
- Not able to verbalize
- Stigma
- Inadequate education
- Not clear standards, so it is based on provider preference
What is the basis of pain managment based on
Based on the patient’s subjective experience
Take with a grain of salt though
What do you use for mild/moderate pain and what are some examples?
NSAIDs 1st line
good for smooth muscles, kidney stones, biliary colic
What do you use for severe pain or inflammation or damaging? What is this NOT useful for?
Opioids
not useful for neuropathic or chronic pain
What does Tylenol processed through? NSAIDs SE? Ketamine lidocaine used for pain in the ER?
tylenol: liver - get LFTs
NSAIDs = GI uspet, take with food (do not take with anticoags)
Keatmine and lidocaine are NOT used for pain
What is toradol CI in?
1st trimester of preggo
get a negative pregnancy test 1st
What is lidocaine gel useful for?
MSK pain
Take off for iritation
Capsaicin indication
post-herpatic neurolagia
Cyclic vomitting
What are the opioids and SE? What is the titration based on?
start with:
- morphine (can cause hypotension)
- hydromorphone
- Fentanyl
- Hydrocodone
- Codeine (bad on stomach)
- Tramadol
titrated up, start low, go slow
opiate naive is the most important history (even more than weight)
what is the worry with tramadol
risk of serotonin syndrome d/t being a weak SNRIs
Addiction vs dependence
Addiction = affects well being
Dependence = cessation of medication results in w/drawl
What are the RFs for addiction/ dependence?
- Alcohol (#1)
- Mental illness
- Drug use
There is no validated assessment tool to classify ED patients for abuse risk. When uncertain, the general approach is to err on the side of acute pain control, using nonopioid options whenever possible.
Consideration upon discharge for opiods with:
1. elderly or narcotic naive
2. getting back home
3. SE
4. DDI
5. People at home
- elderly or narcotic naive: should not be sent home with meds w/out social support
- Do not drive
- Constipation
- Do not take Tylenol or ibruofen w/in 6 hours
- Make sure no one will accidentally or purposefull injest them
What are the MC local anesthetic? What can be added and why?
Lidocaine and bivocaine
can add Epi to increase duration of anestehsia, control wound bleeding, and slow systemic absorbtion
pull back to make sure you did not hit an artery
When should you avoid epi?
digital vascular injury; in patients with vascular disease, such as Raynaud’s or Berger’s disease; or in other conditions in which end-arterial vascular supply is problematic
Three indications for topical anesthecicas
Topical anesthetics are used in three major situations: on intact skin before dermal instrumentation, applied to intact mucosa, and placed on open skin for pain control or before wound repair.
What are the indications for regional anesthetics? What do you need to do this
complicated lacerations, abscesses, fractures, debridement, and dislocations
use for peripheral nerve blocks w/ or w/out US (lidocaine, etc)
digital block is an example
What are the two different digital blocks
Flexor tendon sheath block: not as well, but once (put in between the double crease of the finger)
Digital nerve block: 4 injectons (assess cap refill/sensation before block)
What is considered chronic pain and what should be ruled out?
3 months, pain that persists beyond the reasonable time for an injury to heal, or pain that persists 1 month beyond the usual course of an acute disease
r/o acute pain or limb threatening condition
look for change in baseline pain in the ER
remember, opioids are NOT indicated post-ER chronic pain
What is the job of the ER for chronic pain managment
address acute pain and then send to a pain management specialist
MC faked pain for drug seeking behavior? What are they typically “allergic” to?
Back pain (#1)
HA
Extremity pain
Dental pain
They are “allergic” to NSAIDs or say they are going through w/drawl symptoms
often have a history of illicit drug and alcohol abuse and have a weird MOI. Call security if necessary.
Do not chart “drug seeking behavior” just what you saw/heard.
what is the DDX for lower back pain?
Spinal abscess, spinal stenosis, cauda equina, MSK strain, fracture, kidney stone
