This document discusses assessing, preventing, and managing pain in patients undergoing medical procedures. It lists some of the most painful procedures like chest tube removal and provides references showing patients rate the pain of these procedures highly. It emphasizes the importance of assessing and controlling pain to prevent issues like agitation and delirium. The document provides a stepwise approach to assessing pain in patients who cannot self-report, including looking for behavioral changes and using pain scales. It notes that vital signs alone should not be used to assess pain. Finally, it discusses coordinating spontaneous awakening trials and spontaneous breathing trials for mechanically ventilated patients.