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Pain Management

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  • 1.Something is wrong Tissue is being damaged Limit a person’s function Factors that affect how a person experiences pain. 1. Cultural 2. Social 3. Age 4. Cognitive ability 5. Emotional state
  • Side effects of pain. Pain is a very real feeling and chronic pain can be devastating. These are just a few examples. More examples can be found by searching the web.
  • Nociceptors and sensory neurons 1. Located at nerve endings in the skin, muscle, bone, blood vessels and internal organs Message is transmitted by nerves from the site to the spinal cord Spinal cord to the Brain and Muscles at the site Brain, Releases endorphins, Chemicals Temporary pain relief, Inflammatory response, Protect and repair damage Muscles at the site contracts to prevent further damage
  • Acute=Slow or sudden onset, Mild to severe, Immediate, identifiable cause, Temporary, Protective, Subsides with healing Chronic=Continued more than 6 months, Slow onset, Long lasting, Ono-productive (serves no purpose), Adverse affects, Can limit a person’s physical and mental capabilities, Can incapacitate., Reduces quality of life Differentiate acute from chronic, Time Cause Provide participants with examples of both acute and chronic and ask them to differentiate the two and provide the reason for their decision.
  • Somatic, Nociceptors, Coetaneous / surface , Deep tissue / musculoskeletal , Localized to damaged area Surface somatic pain, Sharp, Stabbing, Prickly / burning Deep somatic pain, Dull, Aching. Responds to Cold packs, Nonsteroidal anti-inflammatory drugs – NSAIDS, Opiates Local anesthetics. Visceral, Internal body organs and cavities, Infiltration, Compression, Extension, Stretching. Pain is Diffuse, Difficult to locate, Pressure-like , Deep squeezing sensation , Cramping. Responds well to opiates Neuropathic Changes or injuries to nervous system. Pain is Severe, Burning or tingling sensation. Causes, Infection Inflammation, Tumors, Scar tissue, Diabetes, Medical conditions. Responds well to opiates. Breakthrough Pain, Brief flare up Severe, Chronic pain sufferers , Quick onset, Temporary, Common for cancer / Hospice Pts.. Responds well to strong short acting pain medications
  • O-Onset of pain Acute vs. Chronic P-Provokes/palliation. Better or Worse Q-Quality, Sharp/stabbing, Dull, Weight, Pressure, Burning, Numbness/tingling R-Radiation, Disease process, MOI S-Severity Pain scales T-Time, When did it start? Constant Better/worse On-going assessment Consider the need for a detailed assessment. Re-assessment, Repeats vital signs, Re-assess to determine if treatment is working
  • O-Onset of pain Acute vs. Chronic P-Provokes/palliation. Better or Worse Q-Quality, Sharp/stabbing, Dull, Weight, Pressure, Burning, Numbness/tingling R-Radiation, Disease process, MOI S-Severity Pain scales T-Time, When did it start? Constant Better/worse On-going assessment Consider the need for a detailed assessment. Re-assessment, Repeats vital signs, Re-assess to determine if treatment is working
  • Addiutional information about pain scales can be found by using the Web.
  • To review each pain scale prior to teaching the following web-sties are useful http://www.anes.ucla.edu/pain/assessment_tools.html http://painconsortium.nih.gov/pain_scales/index.html
  • To review each pain scale prior to teaching the following web-sties are useful http://www.anes.ucla.edu/pain/assessment_tools.html http://painconsortium.nih.gov/pain_scales/index.html
  • To review each pain scale prior to teaching the following web-sties are useful http://www.anes.ucla.edu/pain/assessment_tools.html http://painconsortium.nih.gov/pain_scales/index.html
  • To review each pain scale prior to teaching the following web-sties are useful http://www.anes.ucla.edu/pain/assessment_tools.html http://painconsortium.nih.gov/pain_scales/index.html
  • To review each pain scale prior to teaching the following web-sties are useful http://www.anes.ucla.edu/pain/assessment_tools.html http://painconsortium.nih.gov/pain_scales/index.html
  • To review each pain scale prior to teaching the following web-sties are useful http://www.anes.ucla.edu/pain/assessment_tools.html http://painconsortium.nih.gov/pain_scales/index.html
  • Communication is the primary way we can assess a person’s pain. We will be faced with many barriers to communication and must improve our assessments and use our assessment tools to overcome communication challenges.
  • Communication, Key element, Compassion. How you can help Distraction Change the patients focus Repositioning=Comfort Pad voids, Pillows, Warm, Cool
  • Peripheral acting, Pain detected at the tissues, Non-steroidal anti-inflammatory drugs-NSAIDS, Block the pain impulse that causes the release of inflammatory responses. Centrally acting, Relieve both physical and emotional pain, Common CNS agents are opiates Fentanyl=Preferred analgesic, Few adverse affects, Reduced nausea, sedation and respiratory depression than other CNS agents, Fast acting, Short duration, Most all patients, Dosage 25-100 micrograms, Reversed easily with narcan. Nitronox=50% oxygen, 50% nitrous, Inhaled gas, Rapidly absorbed and delivered to the brain, Few side affects Light-headedness, Nausea, Altered mental status. BLS level of care. Contraindication, Trapped gas, Pneumothorax Small bowel obstruction
  • Peripheral acting, Pain detected at the tissues, Non-steroidal anti-inflammatory drugs-NSAIDS, Block the pain impulse that causes the release of inflammatory responses. Centrally acting, Relieve both physical and emotional pain, Common CNS agents are opiates Fentanyl=Preferred analgesic, Few adverse affects, Reduced nausea, sedation and respiratory depression than other CNS agents, Fast acting, Short duration, Most all patients, Dosage 25-100 micrograms, Reversed easily with narcan. Nitronox=50% oxygen, 50% nitrous, Inhaled gas, Rapidly absorbed and delivered to the brain, Few side affects Light-headedness, Nausea, Altered mental status. BLS level of care. Contraindication, Trapped gas, Pneumothorax Small bowel obstruction
  • Peripheral acting, Pain detected at the tissues, Non-steroidal anti-inflammatory drugs-NSAIDS, Block the pain impulse that causes the release of inflammatory responses. Centrally acting, Relieve both physical and emotional pain, Common CNS agents are opiates Fentanyl=Preferred analgesic, Few adverse affects, Reduced nausea, sedation and respiratory depression than other CNS agents, Fast acting, Short duration, Most all patients, Dosage 25-100 micrograms, Reversed easily with narcan. Nitronox=50% oxygen, 50% nitrous, Inhaled gas, Rapidly absorbed and delivered to the brain, Few side affects Light-headedness, Nausea, Altered mental status. BLS level of care. Contraindication, Trapped gas, Pneumothorax Small bowel obstruction
  • Peripheral acting, Pain detected at the tissues, Non-steroidal anti-inflammatory drugs-NSAIDS, Block the pain impulse that causes the release of inflammatory responses. Centrally acting, Relieve both physical and emotional pain, Common CNS agents are opiates Fentanyl=Preferred analgesic, Few adverse affects, Reduced nausea, sedation and respiratory depression than other CNS agents, Fast acting, Short duration, Most all patients, Dosage 25-100 micrograms, Reversed easily with narcan. Nitronox=50% oxygen, 50% nitrous, Inhaled gas, Rapidly absorbed and delivered to the brain, Few side affects Light-headedness, Nausea, Altered mental status. BLS level of care. Contraindication, Trapped gas, Pneumothorax Small bowel obstruction
  • Pain relief is part of patient care !!!!!! Make sure you do it!!!!!
  • Pain relief is part of patient care !!!!!! Make sure you do it!!!!!

Transcript

  • 1. Pain Management
  • 2. Learning Objectives
    • Cognitive Domain
    • Describe the pathophysiology of pain and different types of pain.
    • Describe the assessment of a patient experiencing pain and use of the OPQRST mnemonic.
    • Identify the various pain scales and how they relate to prehospital assessment.
  • 3. Learning Objectives
    • Cognitive Domain
    • Discuss the role of pain management for BLS and ALS in the prehospital setting.
    • Explain the various non-medication treatments for pain and the pharmacological treatment options for pain management.
  • 4. Learning Objectives
    • Psychomotor Domain
    • Demonstrate properly assessment techniques of a patient complaining of pain.
    • Demonstrate pain-relieving techniques using non-medicated methods.
    • Demonstrate use of pain scales with patients of various cognitive abilities.
    • Demonstrate the ability to identify and treat pain with the appropriate analgesic.
  • 5. Key Vocabulary
    • Acute
    • Agonists
    • Alleviate
    • Analgesia
    • Analgesic
    • Anti-inflammatory
    • Analgesic
    • Breakthrough pain
    • Chronic pain
    • Cognitive
    • CNS Agents
    • Diaphoresis
    • Distract
    • Empathy
    • Endorphins
  • 6. Key Vocabulary (continued)
    • FLACC Behavioral Pain Scale
    • Infiltration
    • Inflammatory
    • Intricate
    • Motivator
    • Non-opioid analgesic
    • Neonate
    • Neonatal Infant Pain Scale (NIPS)
    • Nociceptors
    • Non-Steroidal Anti-Inflammatory Drug (NSAID) Opiates
    • Pain
    • Pain scale
  • 7. Key Vocabulary (continued)
    • Palliation
    • Parasympathetic
    • Persistent pain
    • Perception
    • Peripherally
    • Physiologic
    • Provocation
    • Psychological
    • Receptors
    • Sedation
    • Sensation
    • Sensory neurons
    • Sympathetic
    • Therapeutic
    • Wong-Baker FACES Pain Scale
  • 8. What is Pain?
    • Next to respiratory distress, pain is one of the most common reason’s EMS is requested
    • Protective mechanism
    • Can come on fast or slowly
    • Limits physical abilities
    • Emotional
    • Cognitive
    • Individual
  • 9. Effects of Pain
    • Reduce function
    • Tiredness
    • Reduced appetite, nausea
    • Less sleep, interrupted sleep
    • Less enjoyment
    • More anxiety
    • Depression
    • Loss of concentration
    • Loss of control
    • Less interaction
    • Less sex or affection
    • Appearance change
    • Burden to family and friends
  • 10. How Pain Works
    • Within nervous system
    • Begins at site of injury/illness
    • Nociceptors and sensory neurons
    • Message is transmitted by nerves
    • Spinal cord
    • Brain
    • Muscles at the site
  • 11. Pain Categories
    • Acute
    • Chronic
    • Differentiate acute from chronic
  • 12. Types of Pain
    • Somatic
      • Surface somatic pain
      • Deep somatic pain
    • Visceral
    • Neuropathic
    • Breakthrough pain
  • 13. Assessment
    • Pain management:
      • Important aspect of patient care
      • After life-threats are stabilized
      • Begins with an assessment
    • BSI
    • Scene size-up
  • 14. Assessment (continued)
    • Initial assessment
    • Focused history and physical exam
    • SAMPLE History
    • OPQRST
    • Interventions
      • Non-medication vs. Medicated
  • 15. Pain Scales
    • Assessment tool
    • Apply to patients with communication barriers
    • Available for all ages
      • Some specifically for infants
  • 16. Adult Pain Scales
    • Numerical rating scale
    • 1 2 3 4 5 6 7 8 9 10
    • No Pain Severe Pain
    • Age 8 and up
    • Uses numbers 1-10 to rate pain
      • Challenges
        • Cognitive ability
        • Hearing
        • Language barrier
  • 17. Wong-Baker FACES Pain Scale From Hockenberry MJ, Wilson D, Winkelstein ML: Wong's Essentials of Pediatric Nursing , ed. 7, St. Louis, 2005, p. 1259. Used with permission. Copyright, Mosby.
  • 18. Adult Pain Scales
    • Wong-Baker FACES Pain Scale
      • Ages 3 and up
      • 6 faces to rate pain
        • Simply point
      • Hearing is not a factor
      • Language barriers not a factor
      • Cognitive ability simplified
  • 19. Pediatric Pain Scales
    • CRIES pain scale
    • NIPS (Neonatal Infant Pain Scale)
    • FLACC
    • Wong-Baker FACES
  • 20. Pediatric Pain Scales (continued)
    • NIPS (Neonatal Infant Pain Scale)
      • Ages 0-1
      • 6 criteria, each assigned a number: 0-2
        • Facial expression
        • Cry
        • Breathing patterns
        • Arm movement
        • Leg movement
        • State of arousal
      • Score greater then 3 indicates pain
  • 21. Pediatric Pain Scales (continued)
    • FLACC
      • Ages 2 months to 7 years
      • 5 assessment criteria
        • Assign number 0-2
          • Face
          • Legs
          • Activity
          • Cry
          • Consolability
  • 22. Communication Challenges
    • Loss of hearing
    • Inability to speak
    • Language barrier
    • Inability to read
    • Verbal comprehension
    • Loss of vision
    • Medical conditions
  • 23. Non-medication Pain Management
    • Non-medicated pain management first
    • Techniques:
      • Recognition
      • Empathy
      • Communication
      • Distraction
      • Therapeutic touch
      • Breathing exercises
      • Conversation
      • Repositioning
      • Elevating injuries
      • Applying ice packs
  • 24. Medications
    • Block pain receptors
    • Classifications
      • Peripheral acting
        • NSAIDs
      • Centrally acting
        • Morphine
        • Fentanyl
        • Nitronox
  • 25. Medications (continued)
    • Morphine
      • Widely used
        • Acts within 5-10 minutes
        • Lasts 2-3 hours
      • Causes respiratory depression, and mild peripheral vasodilation
  • 26. Medications (continued)
    • Fentanyl
      • Use increasing
      • Fewer adverse side-effects
      • Fast acting
      • Short lasting
      • Safe on most patients
  • 27. Medications (continued)
    • Nitronox
      • 50-50 oxygen & nitrous
      • Gas is inhaled
      • Rapidly absorbed & delivered to brain
      • Few side effects
        • Contraindication
          • Trapped gas
  • 28. Treatment
    • Initial assessment
    • Focused history and physical exam
      • SAMPLE history
      • OPQRST
    • Stabilize patient
    • Non-medicated pain relief
    • Medicated pain relief
    • Ongoing assessment
  • 29. Applications
    • Local protocols for preferred pain medications, c-spine precautions and priority patient status
    • Recent case review
    • Lessons of Scenario drill
  • 30.
    • 24-7 EMS
    • 888.240.4911
    • Visit our website for additional information
    • www.24-7ems.com