Pain and hypnosis in ed

Hypno-analgesia
in Emergency
Department
Dr Arnaud Depil Duval
Urgences Evreux - Vernon

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

Hypnosis?
• Only hypno-analgésia
• Not a complet hypnosis therapy
• Hypnose adaptée à la mission des urgences

Hypnosis in emergency department, a reality?
• Noisy Atmosphere
• Major stress
• A patient who suffers
• But if it made it easier?...
Man with acute coronary syndrome in firefighters van.
Pain evoluate from 8/10 to 2/10

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…

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

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

Hypno-analgesic
techniques

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?

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

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

In practice

Techniques
Do not say "it's
almost done"

Imagination
Technique n°1

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

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

Be careful
• Avoid asking for the
description
• it can be
embarrassing…
• Depend of the
referencial of
patient

Controlled respiration
Technique n°2

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

Catalepsy of the
eyelids
Technique n°3

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

Make a cocktail!

Multiply the techniques
• Use many techniques if needed
• Abandon one technique for the
benefit of another
Catalepsy of the eyelids
Imagination

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

Exit hypnosis

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

If it doesn’t work?

Failure
• Useless to insist
• Do not make the patient feel
guilty
• But possibly use another
technique ; starting with the
distraction

Self-hypnosis
Because it's not just patients that
matter ...

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

Trainning
Few hypnosis
Few trained staff
Long training
Complete All technics Long Expensive
« Everyday » hypnosis
Mass trainning
Short trainning
Only analgesia Fast Cheap

Distraction
Cheap hypnosis?

Top of the line
• Virtual reality
• Specialized software
• Robot

Cheap
• Soap bubbles
• Distracted children
• Prevents parents from talking ...

Geek
• Augmented reality

Supplied by the
patient ...
• Do not store smartphones
• Use them!
• "The more you are with your Facebook and
the stronger the protection is"

You can resume normal
activity ...

Pain and hypnosis in ed

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