FCA 1111 - EMS Pain Management

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Field Care Audit presented at Redwood Memorial Hospital

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  • FCA 1111 - EMS Pain Management

    1. 1. I Wanna New Drug: Treating the 5th Vital Sign Veronica Bonales, M.D. CEPAmerica Emergency Medicine Humboldt County EMCC PC
    2. 2. Pain Assessment: or How We See Our Patients...
    3. 3. Pain ManagementStudies show EMS & ED personnel fail to recognize andproperly treat pain Oligoanalgesia Undertreatment of pain
    4. 4. Pain ManagementReasons for oligoanalgesia Underestimation of patient’s pain Patient not asked Patient’s level of pain not believed
    5. 5. Pain ManagementHow can we improve...? Make pain the Fifth vital sign Record interventions and reassessment
    6. 6. Assessment Tools: or How do Patients Rate Their Pain...?
    7. 7. Pain ManagementPain travels along nocioceptors from the peripheral to thecentral nervous system to be recognized by the brainModified as it travels along the pathwaysInterpretation includes psychological, physiological,emotional and behavioral dimensions Cannot infer pain level from degree of damage
    8. 8. Pain ManagementPatient self-reporting is “the most reliable indicator of theexistence and intensity of pain.”
    9. 9. Pain Management Techniques of Three Pain Rating ScalesNumerical rating scale (NRS)(patients verbally requested to rate their pain)Rate your pain from 0 (no pain) to 10 (unbearable pain)Verbal rating scale (VRS)(five pain levels are indicated in large print on a sheet given to the patient: no pain, mild pain, moderate pain, severe pain, unbearable pain)Choose the adjective best corresponding to your pain level.Visual analog scale (VAS)(A 100-mm rule with a movable cursor: ‘‘no pain’’ is written at the left end of the horizontal line along which the cursor is moved, and‘‘maximal pain’’ at the right end) Move the cursor along the line to indicate the intensity of your pain. The left end of the line represents ‘‘nopain’’ and the right end the most intense pain imaginable, i.e., excruciating and unbearable pain.
    10. 10. Pain ManagementWhat do we need to do...? Make sure using a pain scale that will be reliable (NRS) Children under 8 cannot self-report, need to be vigilant of their behavior to assess pain
    11. 11. Analgesia: or Who to Give Pain Medications To
    12. 12. Pain ManagementMyth of withholding pain medication for abdominal painMyth of morphine being unsafeMyth of giving treatment delays transport timeConsider analgesia in all patients with isolated extremitytrauma, hip fractures and burns
    13. 13. Pain ManagementRelief of patient’s pain starts with: Use of appropriate wording and distraction away from painful stimuli Keeping parents near children to reduce distress Immobilize fractures, elevate extremities, apply ice packs, pad spinal immobilization devices
    14. 14. Pain ManagementMake pain the fifth Vital SignDon’t judge patientsDon’t infer level of pain based on degree of injuryAssess children under 8 by behaviorDon’t wait until transfer to start alleviating patients pain
    15. 15. Life in the E.D.
    16. 16. docmontey@yahoo.comwww.slideshare.net/docmontey

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