Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Pain Management

3,385 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Pain Management

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

×