2 results
8 - Pain management
- Swaminatha V. Mahadevan, Stanford University School of Medicine, California, Gus M. Garmel, Stanford University School of Medicine, California
-
- Book:
- An Introduction to Clinical Emergency Medicine
- Published online:
- 27 October 2009
- Print publication:
- 26 May 2005, pp 131-142
-
- Chapter
- Export citation
-
Summary
Scope of the problem
Acute pain is the most common complaint of patients presenting to the emergency department (ED), comprising 60% of presenting complaints in one study. Recognition and acknowledgment of a patient's pain, adequate treatment, and timely reassessment are essential to acute pain management in the ED. Unfortunately, it has been demonstrated that many physicians fail to treat pain promptly or adequately in both inpatient and outpatient settings.
Pain
Pain is whatever the experiencing person says it is, existing whenever he or she says it does. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,” “always subjective,” and “learned through experiences related to injury in early life.” Pain includes behavioral and physical indicators, in addition to self-report. Thus, preverbal, nonverbal, or cognitively-impaired individuals who experience pain can benefit from objective pain assessment. Fear and anxiety increase the perception of physical pain – the unfamiliar and frequently unfriendly ED environment does little to ameliorate a patient's pain.
Acute pain is a symptom of injury or illness, which serves the biologic purpose of warning an individual of a problem and limiting activities that might exacerbate it. Acute pain is usually associated with identifiable pathology and causes anxiety. By convention, it is present for less than 6 months.
Chronic, malignant pain is associated with a terminal disease, such as cancer or acquired immune deficiency syndrome (AIDS).
Appendix D - Procedural sedation and analgesia
- Swaminatha V. Mahadevan, Stanford University School of Medicine, California, Gus M. Garmel, Stanford University School of Medicine, California
-
- Book:
- An Introduction to Clinical Emergency Medicine
- Published online:
- 27 October 2009
- Print publication:
- 26 May 2005, pp 725-732
-
- Chapter
- Export citation
-
Summary
Scope of the problem
Procedural sedation and analgesia (PSA) represents one of the great advances in emergency medicine's maturation as a specialty. It has become a routine part of emergency medical practice, encompassing many fundamental clinical skills including airway assessment and management and critical resuscitation skills. PSA is very safe in the hands of a properly-trained practitioner in the correct setting with appropriate monitoring and resuscitation equipment.
Older terminology attempted to describe the state of sedation and analgesia in static terms, such as conscious sedation. This definition required that patients given agents providing both sedation and analgesia remained conscious, and were still able to reflexively protect their airways. The terminology has evolved to reflect the continuum upon which sedation and analgesia occur, ranging from anxiolysis to analgesia and light sedation through deep sedation and general anesthesia. All of these levels may be applied to the emergency department (ED) setting with the exception of general anesthesia; this implies a complete loss of consciousness and protective airway reflexes.
Certain ED procedures and studies commonly require PSA (Table D.1).
General treatment principles
The major considerations in selecting drugs for PSA include sedation, amnesia, analgesia and muscle relaxation. The first step is to determine the desired depth of sedation. A toddler who has sustained a minor head injury and is undergoing a computed tomography (CT) of the head requires much less sedation and essentially no analgesia when compared to a child who is having a burn debrided or a long bone fracture reduced.