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Analgesia in the Field

Published online by Cambridge University Press:  28 June 2012

Ronald D. Stewart
Ronald D. Stewart
Affiliation:
Chief, Department of Emergency Medicine, Sunnybrook Medical Centre, Professor of Surgery and Anaesthesia, University of Toronto
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Extract

Emergency Medical Services and the care of patients in the field have taken giant steps forward over the past decade. Born of the desire of physicians to influence the mortality rates of sudden cardiac death in the community, systems of advanced life support have taken root in the urban centers in the United Kingdom, Australia, the United States, and other countries (1-3). Although originally largely designed around the concept of “mobile coronary care,” these systems soon were deluged with calls for help from all sectors of the community, and faced a variety of medical problems. As trauma gradually became recognized for the killer and maimer of young lives that it is, regional programs of trauma care were developed in the United States and led gradually to the expansion of prehospital and interhospital transport systems in which critically injured patients were being moved about, often over long distances. The growth of emergency medicine as a specialty in its own right has encouraged the study and improvement of systems of disaster and mass casualty management.

Although the focus of these efforts has been largely the overall reduction of death and disability in critically ill or injured patients, controversy continues around not only the extent of field intervention but also the influence of our efforts on the outcome of these patients (4, 5). The importance of particular interventions such as intravenous line placement, administration of certain medications, the use of the pneumatic anti-shock garment, and other sacred cows of prehospital care, all have been questioned of late (6, 7).

Type
Collective Review
Information
Prehospital and Disaster Medicine , Volume 4 , Issue 1 , September 1989 , pp. 31 - 34
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1989

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References

1. Pantridge, JF, Geddes, JS: A mobile intensive care unit in the management of myocardial infarction. Lancet 1967;2:271–173.Google Scholar
2. Cobb, LA, Conn, RD, Samson, WE, et al. : Early experience in the management of sudden death with a mobileintensive/coronary unit, (abstr) Circulation 1970;42(suppl): 144.Google Scholar
3. Lewis, AJ, Ailshie, G, Criley, JM: Prehospital cardiac care in a paramedic mobile intensive care unit., Calif Med 1972;117:1–8.Google Scholar
4. Trunkey, DD: Is ALS necessary for prehospital cardiac care? (editorial) J Trauma 1984;24:86–87.CrossRefGoogle Scholar
5. Smith, P, Boadai, BI, Hill, AS, et al. : Prehospital stabilization of critically injured patients: A failed concept. J Trauma 1985;25:65–70.CrossRefGoogle ScholarPubMed
6. Smith, JP, Bodai, BI: The urban paramedic's scope of practice. JAMA 1985;253:544–548.Google Scholar
7. Shuster, M, Chong, J: Pharmacologic intervention in prehospital care: A critical appraisal. Ann Emerg Med 1989;18:192–196.CrossRefGoogle ScholarPubMed
8. Walraven, G, Harding, J, Milazzo, K, et al. : Manual of Advanced Prehospital Care. Bowie, Md.: Robert J. Brady Co., 1978.Google Scholar
9. Caroline, N: Emergency Care in the Streets. 3d edition. Boston: Little Brown and Co., 1987.Google Scholar
10. Campbell, JE (ed): Basic Trauma Life Support – Advanced Prehospital Care. 2d edition. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1988.Google Scholar
11. Easton, K (ed): Rescue Emergency Care. London: William Heinemann Medical Books Ltd., 1977.Google Scholar
12. Zorab, JSM, Baskett, PJF: Immediate Care. London: WB Saunders Company Ltd., 1977.Google Scholar
13. Baskett, PJ, Withnell, A: Use of entenox in the ambulance service. Br Med J 1970;2:42–43.Google Scholar
14. Marks, RM, Sachar, EJ: Undertreatment of medical inpatients with narcotic analgesics. Ann Intern Med 1973;78:173–181.Google Scholar
15. Cohen, FL: Postsurgical pain relief: Patients' status and nurses' medication choices. Pain 1980;9:265–274.Google Scholar
16. Reichl, M, Bodiwala, GG: Use of analgesia in severe pain in the accident and the emergency department. Arch Emerg Med 1987;4:25–31.CrossRefGoogle Scholar
17. Beecher, BK: The control of pain in men wounded in battle. In: Surgery in World War II, Vol II: General Surgery. Washington, DC: Office of the Surgeon General, Department of the Army, 1955.Google Scholar
18. Bonica, JJ: Pain control in mass casualties. In: Manni, C, Magalini, SI (eds): Emergency and Disaster Medicine, Proceedings of the Third World Congress, Rome, 1983, Berlin: Springer-Verlag, 1985.Google Scholar
19. Bion, JF: Pain control in mass casualties. Anaesthesia 1984;39:560–564.Google Scholar
20. Whitehead, DC: Patients in pain. Emerg Med Serv 1986;15:20–21.Google Scholar
21. Analgesia and the acute abdomen, (editorial) Br Med J 1979;2:1093.CrossRefGoogle Scholar
22. Podgorny, G: Abdominal pain and analgesia, (editorial) Ann Emerg Med 1981;10:547.CrossRefGoogle ScholarPubMed
23. Criley, JM, Niemann, JT, Rosborough, JP: Cardiopulmonary resuscitation research 1960–1984: Discoveries and advances. Ann Emerg Med 1984;13:756–758.CrossRefGoogle ScholarPubMed
24. Stewart, RD: Pain control in prehospital care. In: Paris, PM, Stewart, RD (eds): Pain Management in Emergency Medicine. Norwalk, Conn.: Appleton & Lange, 1988, p 314.Google Scholar
25. Bilmire, DA, Neale, HW, Gregory, RO: Use of IV fentanyl in the outpatient treatment of pediatric facial trauma. J Trauma 1985;25:1079–1080.Google Scholar
26. Paris, PM, Weiss, LD: Narcotic analgesics: The pure agonists. In: Paris, PM, Stewart, RD (eds): Pain Management in Emergency Medicine. Norwalk, Conn.: Appleton & Lange, 1988, pp 147–148.Google Scholar
27. Stene, JK, Stofberg, L, MacDonald, G, et al. : Nalbuphine analgesia in the prehospital setting. Am J Emerg Med 1988;6:634–639.Google Scholar
28. Lewis, LA: Methoxyflurane analgesia for office surgery. J Dermatol Surg Oncol 1984;10:85–86.CrossRefGoogle ScholarPubMed
29. Stewart, RD: Pain control in prehospital care. In: Paris, PM, Stewart, RD (eds): Pain Management in Emergency Medicine. Norwalk, Conn., 1988, p 318.Google Scholar
30. Paris, PM, Kaplan, RM, Ryan, JL, et al. : A prospective prehospital trial for nitrous oxide use in urban and suburban systems: A study of efficacy and side effects (abstr). Ann Emerg Med 1988;17:425.Google Scholar
31. Caro, DB: Trial of ketamine in an accident and emergency department. Anaesthesia 1974;29:227–229.Google Scholar
32. Dailey, RH, Stone, R, Repert, W: Ketamine dissociative anesthesia: Emergency Department use in children. JACEP 1979;8:53–56.CrossRefGoogle ScholarPubMed
34. Tobin, HA: Low-dose ketamine and diazepam. Arch Otolaryngol 1982;108:439–440.Google Scholar
35. Cartwright, PD, Pingel, SM: Midazolam and diazepam in ketamine anesthesia. Anaesthesia 1984;39:439–442.CrossRefGoogle Scholar
36. Mock, DL, Streisand, JB, Hague, B, et al. : Transmucosal narcotic delivery: An evaluation of fentanyl (lollipop) premedication in man. Anesth Analg 1986;65:S201.Google Scholar
37. Henderson, JM, Brodsky, DA, Fisher, DM, et al. : Preinduction of anesthesia in pediatric patients with nasally administered sufentanil. Anaesthesiology 1988;68:671–675.CrossRefGoogle ScholarPubMed
38. Russell, LJ, Aldrete, JA: Intranasal ketamine: Preliminary pharmacokinetics. Read before the 9th World Congress of Anaesthesiology, Washington, DC., 1988.Google Scholar