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Pain and hypnosis in ed

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Use hypnosis in a emergency department to fight against pain

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Pain and hypnosis in ed

  1. 1. Hypno-analgesia in Emergency Department Dr Arnaud Depil Duval Urgences Evreux - Vernon
  2. 2. What’s that? What it is not • Takeover by a « guru » • Unwanted acts It is • Physiological state • Natural • Subconscious protection Dr Arnaud Depil Duval - Urgences Evreux Vernon
  3. 3. Hypnosis? • Only hypno-analgésia • Not a complet hypnosis therapy • Hypnose adaptée à la mission des urgences Dr Arnaud Depil Duval - Urgences Evreux Vernon
  4. 4. Hypnosis in emergency department, a reality? • Noisy Atmosphere • Major stress • A patient who suffers • But if it made it easier?... Dr Arnaud Depil Duval - Urgences Evreux Vernon Man with acute coronary syndrome in firefighters van. Pain evoluate from 8/10 to 2/10
  5. 5. When use hypno-analgesia in emergency department? • Arterial puncture • Lumbar puncture • Thoracic drainage • Dislocation • Fracture • Suture (face+++) • Prepare sedation for invasive acts • Acute Coronary Syndrome • Non invasive ventilation… Dr Arnaud Depil Duval - Urgences Evreux Vernon
  6. 6. From positive communication to hypnosis • Base of hypnosis • Always use positive terms • Avoid negative terms : • Don’t panic • No stress • Be careful, i will going to sting Dr Arnaud Depil Duval - Urgences Evreux Vernon
  7. 7. Speaking about hypnosis • Rule n°1 : It is forbidden to say “hypnosis” • Rule n°2 : It is forbidden to say “hypnosis” • Rule n°3 : Get patient acceptation • Rule n°4 : If opposition, stop hypnosis • Rule n°5 : Use transitions sentences and adapted attitudes Dr Arnaud Depil Duval - Urgences Evreux Vernon
  8. 8. Hypno-analgesic techniques Dr Arnaud Depil Duval - Urgences Evreux Vernon
  9. 9. 3 « Yes » • Get acceptance from patient • Knock down oppositions • Obvious questions : • Could you look a point on the wall? • Do you hear sounds around you? • Could you feel the stretcher? Dr Arnaud Depil Duval - Urgences Evreux Vernon
  10. 10. Positive communication • Expliquer le geste avant • Et ne plus en reparler • Choisir ensuite des formules adaptées et positives : • L’infirmier va faire ce qu’il a à faire • L’infirmière va faire le soin • Je vais faire le geste Dr Arnaud Depil Duval - Urgences Evreux Vernon
  11. 11. Analgesic ou co- analgesic? • Tell patient : • “We prepare a treatment to ease you” • “During this step, we can try something else to help you…” • Limit anxiety • Multi-modal analgesia Dr Arnaud Depil Duval - Urgences Evreux Vernon
  12. 12. In practice Dr Arnaud Depil Duval - Urgences Evreux Vernon
  13. 13. Techniques Dr Arnaud Depil Duval - Urgences Evreux Vernon Do not say "it's almost done"
  14. 14. Imagination Technique n°1 Dr Arnaud Depil Duval - Urgences Evreux Vernon
  15. 15. Imagination The more you are in this place and the stronger the protection is Think of a place you like or an activity you like Dr Arnaud Depil Duval - Urgences Evreux Vernon
  16. 16. Pediatric version • More directive • Think of something you like to do • The more you are in this place and the flabbyer your arm ... • Use respiration to escort activity Dr Arnaud Depil Duval - Urgences Evreux Vernon
  17. 17. Be careful • Avoid asking for the description • it can be embarrassing… • Depend of the referencial of patient Dr Arnaud Depil Duval - Urgences Evreux Vernon
  18. 18. Controlled respiration Technique n°2 Dr Arnaud Depil Duval - Urgences Evreux Vernon
  19. 19. Controlled respiration Dr Arnaud Depil Duval - Urgences Evreux Vernon Feel the air enter your right nostril Then in the left Feel the air fill your lungs And your diaphragm will go down and up The more you feel your diaphragm lower and rise and the stronger the protection
  20. 20. Catalepsy of the eyelids Technique n°3 Dr Arnaud Depil Duval - Urgences Evreux Vernon
  21. 21. Catalepsy of the eyelids Close your eyes You will pretend that the eyelids are glued to each other with glue You will pretend to test their closure as if your eyelids were stuck to each other Your eyelids are glued to each other The more your eyelids are glued to each other More protection is strong Dr Arnaud Depil Duval - Urgences Evreux Vernon
  22. 22. Make a cocktail! Dr Arnaud Depil Duval - Urgences Evreux Vernon
  23. 23. Multiply the techniques • Use many techniques if needed • Abandon one technique for the benefit of another Controlled respiration Catalepsy of the eyelids Imagination Dr Arnaud Depil Duval - Urgences Evreux Vernon
  24. 24. Multiply the techniques You can keep your eyes open but it's more comfortable if you close them Breathe through the nose, feel the air enter your nostrils; the right then the left You will pretend that your eyelids are glued to each other You're going to pretend to test their closure, you'll pretend nothing could take them off The more they are glue and the stronger the analgesia And at the same time, you're going to think of a place you like or something you like to do And the more you are in this place, the stronger the analgesia
  25. 25. Exit hypnosis Dr Arnaud Depil Duval - Urgences Evreux Vernon
  26. 26. Exit • Soft • Don’t say “It’s almost done” • Escort the “surfacing” • Respect the rhythm of the patient • Eventually incite "Now you can heal your eyes“ • Always finish with positive note
  27. 27. If it doesn’t work? Dr Arnaud Depil Duval - Urgences Evreux Vernon
  28. 28. Failure • Useless to insist • Do not make the patient feel guilty • But possibly use another technique ; starting with the distraction Dr Arnaud Depil Duval - Urgences Evreux Vernon
  29. 29. Self-hypnosis Because it's not just patients that matter ... Dr Arnaud Depil Duval - Urgences Evreux Vernon
  30. 30. Self-hypnosis • Promotes power nap (micro nap) • Potential optimization technique • Partnership with the Sports • French Air Force and IRBA • Stress and fatigue management Optimization of tasks
  31. 31. Learn
  32. 32. Trainning Few hypnosis Few trained staff Long training Complete All technics Long Expensive « Everyday » hypnosis Mass trainning Short trainning Only analgesia Fast Cheap Dr Arnaud Depil Duval - Urgences Evreux Vernon
  33. 33. Distraction Cheap hypnosis? Dr Arnaud Depil Duval - Urgences Evreux Vernon
  34. 34. Top of the line • Virtual reality • Specialized software • Robot Dr Arnaud Depil Duval - Urgences Evreux Vernon
  35. 35. Cheap • Soap bubbles • Distracted children • Prevents parents from talking ... Dr Arnaud Depil Duval - Urgences Evreux Vernon
  36. 36. Geek • Augmented reality Dr Arnaud Depil Duval - Urgences Evreux Vernon
  37. 37. Supplied by the patient ... • Do not store smartphones • Use them! • "The more you are with your Facebook and the stronger the protection is" Dr Arnaud Depil Duval - Urgences Evreux Vernon
  38. 38. You can resume normal activity ...

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