The document discusses pain management in children. It defines pain and describes how children experience pain beginning in the womb. While the nervous system is developed enough for pain perception at a young age, children have physiological, cognitive, behavioral and emotional factors that influence their experience of pain compared to adults. The document advocates for adequate pain assessment and treatment in children to prevent long-term negative impacts from untreated pain.
- Pediatric pain management requires a multidisciplinary team approach to properly assess and treat a child's pain. This includes addressing physiological, sensory, cognitive, behavioral, and affective components of pain.
- It is important to believe the child's reports of pain, listen to parents and children, and consult other experts when needed. Treatment should be individualized and non-pharmacological options considered in addition to pharmacological interventions.
- Common opioid medications used for pediatric pain include morphine, hydromorphone, fentanyl, and methadone. Non-opioid options also have a role to play depending on the situation. Proper protocols and guidelines help ensure children's pain is well-managed
This document provides an overview of acute pain management in children. It discusses the difficulties in assessing and treating pain in children, as well as the physiological and behavioral effects of acute pain. General principles for managing acute pain in children include anticipating and preventing pain, adequately assessing pain using age-appropriate tools, using a multi-modal approach including pharmacological and non-pharmacological therapies, involving parents, and using non-noxious routes of medication administration when possible. Specific pharmacological therapies for acute pain in children such as acetaminophen, NSAIDs, opioids, and local anesthetics are also reviewed.
This document provides an overview of pain management in children. It defines pain, discusses barriers to treatment, and consequences of untreated pain. Assessment tools like the Wong-Baker Faces scale are presented. A variety of pharmacological and non-pharmacological interventions are reviewed. The World Health Organization principles of pediatric acute pain management are outlined, emphasizing a multimodal approach, regular dosing, and individualizing treatment based on the child's needs. Opioids are discussed along with considerations of tolerance, dependence, and addiction.
Awareness and assessment of the pain in
postoperative children is important
Remember the different pharmacology in
neonates, infants and children
Multi-modal approach to preventing and treating
pain to minimize adverse effects
Regional analgesia must be considered unless
contraindicated
This document summarizes the 10th edition updates to the Advanced Trauma Life Support (ATLS) guidelines. It outlines the initial assessment process including the primary and secondary surveys. It provides updates to various body system-specific guidelines including new recommendations for airway management, shock classification and treatment, thoracic trauma management including tension pneumothorax, head trauma management including blood pressure targets, and spinal motion restriction. It also summarizes pediatric-specific guidelines including fluid resuscitation amounts and head CT criteria. Transfer communication is emphasized including avoiding unnecessary tests and using an ABC-SBAR template.
This document discusses pain management in cancer patients. It notes that 75% of advanced cancer patients experience pain, with one third having a single pain site and one third having two or more pain sites. Pain management involves a multidimensional evaluation and may include modification of the pathological process, non-drug methods, interruption of pain pathways, modification of lifestyle, and use of analgesics like opioids, non-opioids, and adjuvants. Strong opioids combined with non-opioids and adjuvants are recommended for severe pain.
This document provides an overview of pain, including definitions, classifications, physiology, assessment, and management. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is classified based on location, duration (acute vs chronic), and intensity (mild, moderate, severe). The physiology of pain involves transduction, transmission, modulation, and perception of pain signals in the nervous system. Nurses assess pain using scales and treat it using pharmacological and non-pharmacological methods based on the type and severity of the pain.
- Pediatric pain management requires a multidisciplinary team approach to properly assess and treat a child's pain. This includes addressing physiological, sensory, cognitive, behavioral, and affective components of pain.
- It is important to believe the child's reports of pain, listen to parents and children, and consult other experts when needed. Treatment should be individualized and non-pharmacological options considered in addition to pharmacological interventions.
- Common opioid medications used for pediatric pain include morphine, hydromorphone, fentanyl, and methadone. Non-opioid options also have a role to play depending on the situation. Proper protocols and guidelines help ensure children's pain is well-managed
This document provides an overview of acute pain management in children. It discusses the difficulties in assessing and treating pain in children, as well as the physiological and behavioral effects of acute pain. General principles for managing acute pain in children include anticipating and preventing pain, adequately assessing pain using age-appropriate tools, using a multi-modal approach including pharmacological and non-pharmacological therapies, involving parents, and using non-noxious routes of medication administration when possible. Specific pharmacological therapies for acute pain in children such as acetaminophen, NSAIDs, opioids, and local anesthetics are also reviewed.
This document provides an overview of pain management in children. It defines pain, discusses barriers to treatment, and consequences of untreated pain. Assessment tools like the Wong-Baker Faces scale are presented. A variety of pharmacological and non-pharmacological interventions are reviewed. The World Health Organization principles of pediatric acute pain management are outlined, emphasizing a multimodal approach, regular dosing, and individualizing treatment based on the child's needs. Opioids are discussed along with considerations of tolerance, dependence, and addiction.
Awareness and assessment of the pain in
postoperative children is important
Remember the different pharmacology in
neonates, infants and children
Multi-modal approach to preventing and treating
pain to minimize adverse effects
Regional analgesia must be considered unless
contraindicated
This document summarizes the 10th edition updates to the Advanced Trauma Life Support (ATLS) guidelines. It outlines the initial assessment process including the primary and secondary surveys. It provides updates to various body system-specific guidelines including new recommendations for airway management, shock classification and treatment, thoracic trauma management including tension pneumothorax, head trauma management including blood pressure targets, and spinal motion restriction. It also summarizes pediatric-specific guidelines including fluid resuscitation amounts and head CT criteria. Transfer communication is emphasized including avoiding unnecessary tests and using an ABC-SBAR template.
This document discusses pain management in cancer patients. It notes that 75% of advanced cancer patients experience pain, with one third having a single pain site and one third having two or more pain sites. Pain management involves a multidimensional evaluation and may include modification of the pathological process, non-drug methods, interruption of pain pathways, modification of lifestyle, and use of analgesics like opioids, non-opioids, and adjuvants. Strong opioids combined with non-opioids and adjuvants are recommended for severe pain.
This document provides an overview of pain, including definitions, classifications, physiology, assessment, and management. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is classified based on location, duration (acute vs chronic), and intensity (mild, moderate, severe). The physiology of pain involves transduction, transmission, modulation, and perception of pain signals in the nervous system. Nurses assess pain using scales and treat it using pharmacological and non-pharmacological methods based on the type and severity of the pain.
1) A 25-year-old male was in a high-speed head-on collision as an unrestrained driver and is unresponsive upon arrival with abnormal vital signs and injuries.
2) During the primary survey, the team will follow the ATLS protocol to simultaneously assess and treat the patient's airway, breathing, circulation, disability, and exposure (ABCDEs).
3) Adjuncts like diagnostic tools, vital sign monitoring, and urinary/gastric catheters will be used as needed during primary survey and resuscitation before proceeding to secondary survey and definitive care, with continuous re-evaluation of the stabilized patient.
This document discusses the pharmacotherapy of sedatives and analgesics in the ICU. It begins by explaining how pain and stress are major issues for ICU patients and outlines the stress response. It then discusses pain pathways and various modalities for pain control, including drugs like opioids, NSAIDs, and drugs for neuropathic pain. The document provides details on commonly used intravenous opioids and their dosing, adverse effects, and precautions. It also covers sedation in the ICU, including use of benzodiazepines, propofol, barbiturates, and alpha-2 agonists to manage anxiety and achieve calm. Monitoring of sedation using scales like RASS and SAS is emphasized.
Pain results from various pathological processes and is highly subjective, depending on factors like culture, age, and individual experience. Effective pain management requires regular assessment of pain intensity before and after administering analgesics using verbal or observational scales. Pain is evaluated based on characteristics like intensity, pattern, and aggravating/relieving factors to determine if it is nociceptive, neuropathic, or mixed and guide appropriate treatment.
Methods of Pain Assessment in Children.pptxasst professer
This document discusses various tools used to assess pain in children of different ages, from neonates to adolescents. It describes scales that evaluate behaviors like facial expressions, crying, and body language to measure pain in infants. Tools for older children that rely more on self-report are also outlined, such as visual scales using faces or numbers to rate pain intensity. The document stresses the importance of thorough pain assessment and non-pharmacological approaches to reduce pain during medical procedures for children.
Acute pain management involves classifying pain and identifying its underlying cause. Treatment options include nonopioid medications like acetaminophen and NSAIDs, opioids, and adjuvant analgesics. Opioids are effective for moderate to severe acute pain but can cause adverse effects like respiratory depression, nausea, and constipation. Adjuvant analgesics like gabapentin, pregabalin, and ketamine may enhance opioid analgesia and reduce opioid requirements and side effects. Close monitoring is important when using opioids to manage acute pain.
This document provides information on pain assessment and management. It discusses:
- Common types of pain including acute, chronic, cancer, and breakthrough pain.
- Tools for assessing pain such as visual scales, verbal scales, and numeric rating scales from 0-10.
- Pharmacological approaches to pain management including the WHO analgesic ladder with steps from non-opioids to mild then strong opioids.
- Non-pharmacological approaches like relaxation, distraction, TENS, and hypnosis.
- Side effects of pain medications like constipation and risks of opioids like respiratory depression.
Rapidly assess and address life-threatening conditions following the ABCDE method: Airway, Breathing, Circulation, Disability, Exposure/Environmental control. Evaluate the patient's verbal communication, Glasgow Coma Scale, and for signs of foreign objects or facial fractures. Maintain cervical spine immobilization unless necessary for evaluation or treatment, ensuring inline stabilization is provided.
This document discusses classifications of pain. It defines pain according to several organizations and researchers. It notes the historical understanding of pain from Greek, Latin, and early philosophers' perspectives. It then describes types of pain based on speed of onset and duration, including experimental, transient, acute, and chronic pain. It also discusses types based on stimulation level, including somatic and visceral pain. The document outlines specific pains such as headaches, toothaches, and trigeminal neuralgia. It concludes by defining abnormal pains including hyperalgesia, allodynia, hyperpathia, and phantom limb pain.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
Dr. Kumar presented on acute pain management. He discussed how acute pain is initiated by nociceptors and transmitted through three neurons to the brain. Poorly managed acute pain can lead to central sensitization and chronic pain. He described the anatomy and pathways of acute pain transmission, including modulation by descending pathways. Drugs like opioids, NSAIDs, ketamine, alpha-2 agonists, and gabapentinoids were discussed as treatment options, as well as patient-controlled analgesia and regional anesthesia techniques.
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
This document discusses pain and its treatment. It begins by defining pain and classifying common types of pain conditions. It then discusses the body's reflex responses to pain and the endorphin system that modulates pain. It describes the differences between acute and chronic pain and methods of pain measurement. Various treatment options are provided for different types of pain, including NSAIDs, opioids, tramadol, tapentadol, muscle relaxants, and sodium channel blockers. Newer treatments discussed include epirisone and the comparative properties of different NSAIDs, muscle relaxants, tramadol, and tapentadol. Key questions are also provided about comparing treatment effectiveness and safety across patient subgroups.
Postoperative pain is harmful and leads to both acute and chronic negative effects if poorly controlled. A multimodal approach to pain management is recommended, utilizing both pharmacological and non-pharmacological techniques. This includes the use of opioids, non-opioid analgesics like NSAIDs and gabapentinoids, and regional analgesic techniques such as epidurals, peripheral nerve blocks, and trigger point injections to provide superior pain relief with fewer side effects than systemic opioids alone. The goal is to control pain and facilitate early recovery after surgery.
This document discusses pain management and treatment modalities. It defines pain and describes types of pain such as acute and chronic. It also discusses peripheral nerve fibers involved in pain perception. The major categories of pain are nociceptive and neuropathic pain. Pain assessment instruments include single-dimension scales like VAS and multidimensional scales. Principles of treatment include reduction of pain through various methods and rehabilitation. Treatment modalities discussed include analgesic agents like opioids, adjuvants, and non-pharmacological methods. Specific analgesics like paracetamol, NSAIDs, opioids, tramadol, and local anesthesia are also covered.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
1) Seizures are caused by abnormal electrical activity in the brain and can be triggered by factors like infections, metabolic imbalances, medications, trauma and certain genetic conditions.
2) Management of seizures involves stabilizing the patient, administering anti-seizure medications like lorazepam or diazepam to stop ongoing seizures, treating any identifiable underlying causes, and using longer-acting medications like phenytoin or phenobarbital to prevent recurrent seizures.
3) Prolonged or repeated seizures (status epilepticus) require more aggressive treatment that may include additional benzodiazepines, phenytoin, phenobarbital, or pentobarbital anesthesia
Pain can be described as sharp or dull with a burning sensation in the relevant body parts. It might vary from being steady to fluctuating. The intensity and nature of the pain can vary from one body part to another.
This document provides an overview of pain pathophysiology and management. It begins with objectives and introduces topics like neuroanatomy, pathophysiology, types of pain, assessment, and management. It describes how pain is a subjective experience transmitted by nociceptors and modulated by various factors. The neuroanatomy of pain transmission from the periphery to the CNS is outlined. Different types of pain like nociceptive, neuropathic, referred, acute, and chronic are defined. Common pain syndromes and their characteristics are mentioned. Non-opioid and opioid medications as well as non-pharmacological approaches for pain management are summarized.
1) A 25-year-old male was in a high-speed head-on collision as an unrestrained driver and is unresponsive upon arrival with abnormal vital signs and injuries.
2) During the primary survey, the team will follow the ATLS protocol to simultaneously assess and treat the patient's airway, breathing, circulation, disability, and exposure (ABCDEs).
3) Adjuncts like diagnostic tools, vital sign monitoring, and urinary/gastric catheters will be used as needed during primary survey and resuscitation before proceeding to secondary survey and definitive care, with continuous re-evaluation of the stabilized patient.
This document discusses the pharmacotherapy of sedatives and analgesics in the ICU. It begins by explaining how pain and stress are major issues for ICU patients and outlines the stress response. It then discusses pain pathways and various modalities for pain control, including drugs like opioids, NSAIDs, and drugs for neuropathic pain. The document provides details on commonly used intravenous opioids and their dosing, adverse effects, and precautions. It also covers sedation in the ICU, including use of benzodiazepines, propofol, barbiturates, and alpha-2 agonists to manage anxiety and achieve calm. Monitoring of sedation using scales like RASS and SAS is emphasized.
Pain results from various pathological processes and is highly subjective, depending on factors like culture, age, and individual experience. Effective pain management requires regular assessment of pain intensity before and after administering analgesics using verbal or observational scales. Pain is evaluated based on characteristics like intensity, pattern, and aggravating/relieving factors to determine if it is nociceptive, neuropathic, or mixed and guide appropriate treatment.
Methods of Pain Assessment in Children.pptxasst professer
This document discusses various tools used to assess pain in children of different ages, from neonates to adolescents. It describes scales that evaluate behaviors like facial expressions, crying, and body language to measure pain in infants. Tools for older children that rely more on self-report are also outlined, such as visual scales using faces or numbers to rate pain intensity. The document stresses the importance of thorough pain assessment and non-pharmacological approaches to reduce pain during medical procedures for children.
Acute pain management involves classifying pain and identifying its underlying cause. Treatment options include nonopioid medications like acetaminophen and NSAIDs, opioids, and adjuvant analgesics. Opioids are effective for moderate to severe acute pain but can cause adverse effects like respiratory depression, nausea, and constipation. Adjuvant analgesics like gabapentin, pregabalin, and ketamine may enhance opioid analgesia and reduce opioid requirements and side effects. Close monitoring is important when using opioids to manage acute pain.
This document provides information on pain assessment and management. It discusses:
- Common types of pain including acute, chronic, cancer, and breakthrough pain.
- Tools for assessing pain such as visual scales, verbal scales, and numeric rating scales from 0-10.
- Pharmacological approaches to pain management including the WHO analgesic ladder with steps from non-opioids to mild then strong opioids.
- Non-pharmacological approaches like relaxation, distraction, TENS, and hypnosis.
- Side effects of pain medications like constipation and risks of opioids like respiratory depression.
Rapidly assess and address life-threatening conditions following the ABCDE method: Airway, Breathing, Circulation, Disability, Exposure/Environmental control. Evaluate the patient's verbal communication, Glasgow Coma Scale, and for signs of foreign objects or facial fractures. Maintain cervical spine immobilization unless necessary for evaluation or treatment, ensuring inline stabilization is provided.
This document discusses classifications of pain. It defines pain according to several organizations and researchers. It notes the historical understanding of pain from Greek, Latin, and early philosophers' perspectives. It then describes types of pain based on speed of onset and duration, including experimental, transient, acute, and chronic pain. It also discusses types based on stimulation level, including somatic and visceral pain. The document outlines specific pains such as headaches, toothaches, and trigeminal neuralgia. It concludes by defining abnormal pains including hyperalgesia, allodynia, hyperpathia, and phantom limb pain.
A powerpoint explaining in detail about all the intravenous induction agents and their clinical uses, pharmacokinetics & pharmacodynamics, adverse effects and complications.
Dr. Kumar presented on acute pain management. He discussed how acute pain is initiated by nociceptors and transmitted through three neurons to the brain. Poorly managed acute pain can lead to central sensitization and chronic pain. He described the anatomy and pathways of acute pain transmission, including modulation by descending pathways. Drugs like opioids, NSAIDs, ketamine, alpha-2 agonists, and gabapentinoids were discussed as treatment options, as well as patient-controlled analgesia and regional anesthesia techniques.
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
Management of patient with increased intracranial pressuresalman habeeb
This document discusses the management of increased intracranial pressure. It defines intracranial pressure and its normal compensatory mechanisms. Common causes of increased ICP including brain edema are explained. Signs and symptoms as well as diagnostic tests and methods for measuring ICP are covered. Goals and approaches for medical and surgical management to reduce ICP are outlined.
This document discusses pain and its treatment. It begins by defining pain and classifying common types of pain conditions. It then discusses the body's reflex responses to pain and the endorphin system that modulates pain. It describes the differences between acute and chronic pain and methods of pain measurement. Various treatment options are provided for different types of pain, including NSAIDs, opioids, tramadol, tapentadol, muscle relaxants, and sodium channel blockers. Newer treatments discussed include epirisone and the comparative properties of different NSAIDs, muscle relaxants, tramadol, and tapentadol. Key questions are also provided about comparing treatment effectiveness and safety across patient subgroups.
Postoperative pain is harmful and leads to both acute and chronic negative effects if poorly controlled. A multimodal approach to pain management is recommended, utilizing both pharmacological and non-pharmacological techniques. This includes the use of opioids, non-opioid analgesics like NSAIDs and gabapentinoids, and regional analgesic techniques such as epidurals, peripheral nerve blocks, and trigger point injections to provide superior pain relief with fewer side effects than systemic opioids alone. The goal is to control pain and facilitate early recovery after surgery.
This document discusses pain management and treatment modalities. It defines pain and describes types of pain such as acute and chronic. It also discusses peripheral nerve fibers involved in pain perception. The major categories of pain are nociceptive and neuropathic pain. Pain assessment instruments include single-dimension scales like VAS and multidimensional scales. Principles of treatment include reduction of pain through various methods and rehabilitation. Treatment modalities discussed include analgesic agents like opioids, adjuvants, and non-pharmacological methods. Specific analgesics like paracetamol, NSAIDs, opioids, tramadol, and local anesthesia are also covered.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
1) Seizures are caused by abnormal electrical activity in the brain and can be triggered by factors like infections, metabolic imbalances, medications, trauma and certain genetic conditions.
2) Management of seizures involves stabilizing the patient, administering anti-seizure medications like lorazepam or diazepam to stop ongoing seizures, treating any identifiable underlying causes, and using longer-acting medications like phenytoin or phenobarbital to prevent recurrent seizures.
3) Prolonged or repeated seizures (status epilepticus) require more aggressive treatment that may include additional benzodiazepines, phenytoin, phenobarbital, or pentobarbital anesthesia
Pain can be described as sharp or dull with a burning sensation in the relevant body parts. It might vary from being steady to fluctuating. The intensity and nature of the pain can vary from one body part to another.
This document provides an overview of pain pathophysiology and management. It begins with objectives and introduces topics like neuroanatomy, pathophysiology, types of pain, assessment, and management. It describes how pain is a subjective experience transmitted by nociceptors and modulated by various factors. The neuroanatomy of pain transmission from the periphery to the CNS is outlined. Different types of pain like nociceptive, neuropathic, referred, acute, and chronic are defined. Common pain syndromes and their characteristics are mentioned. Non-opioid and opioid medications as well as non-pharmacological approaches for pain management are summarized.
Dr. Fatma Al-Dammas is an anesthesiology professor and director of the anesthesia and acute/chronic pain management programs. She specializes in managing pain, which requires a multidisciplinary team approach. The goals of pain treatment are to improve quality of life, facilitate recovery, reduce morbidity, and allow for early hospital discharge. Pain management involves both pharmacological and non-pharmacological approaches, including the WHO pain ladder and various methods of drug delivery like epidural analgesia. Epidural analgesia provides effective post-operative pain relief, improves pulmonary function, and enables earlier ambulation.
Pain is a complex, multidimensional experience that is always subjective. It is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage." There are several types of pain including nociceptive, neuropathic, acute, chronic, and cancer pain. Pain should be assessed using scales like the numeric scale or Wong-Baker FACES scale to evaluate severity and impact. Unrelieved pain can have adverse effects physically, psychologically, and on quality of life. A multidimensional approach to pain management includes both pharmacological and non-pharmacological strategies to treat pain, maintain function, and enhance well-being.
Headache Attributed to Nonvascular, Noninfectious
Intracranial Disorders
Headache Attributed to Trauma or Injury to the Head
and/or Neck
Headache Attributed to Infection
Headache Attributed to Cranial or Cervical Vascular
Disorders
Headache Associated with Disorders of Homeostasis
Headache Caused by Disorders of the Cranium, Neck,
Eyes, Ears, Nose, Sinuses, Teeth, Mouth, or Other
Facial or Cranial Structures
Headaches and the Cervical Spine
Migraine
Chronic Daily Headache
Cluster Headache
Other Trigeminal Autonomic Cephalalgias
Other Primary Headaches
Unit no.:3
Unit Name: Nursing care of patients with common sign and symptoms and management
Subject: Adult Health Nursing -I
Topic: PAIN
Prepared by: Misfa Khatun, Nursing Tutor
Sue Barnes - Pain management and Multiple SclerosisMS Trust
This document provides an overview of pain management for patients with multiple sclerosis (MS). It defines different types of pain commonly experienced by MS patients, such as Lhermitte's sign and central neuropathic dysaesthesia. Neuropathic pain is discussed in more detail, including its pathophysiology and diagnosis. Common neuropathic pain medications for MS are presented, including amitriptyline, gabapentin, pregabalin, and opioids. National guidelines for treating neuropathic pain in MS are summarized. Specialist referral is recommended for complex pain or when first-line treatments are ineffective.
Comprehensive description of pain pathways which covers related definitions, benefits, theories, classification and mechanism of pain with factors that affect pain and diagnosis of pain. Also covers assessment and management of pain along with brief description of ascending and descending pain pathways.
The document discusses vital signs, which are important indicators of a patient's health status. It describes the four main vital signs - temperature, pulse, respiration, and blood pressure. For each vital sign, it provides the normal ranges and explains how they are measured. It also discusses factors that can cause vital signs to increase or decrease outside of normal ranges. Pain is referred to as a fifth vital sign. Proper assessment and documentation of vital signs are important for monitoring changes in a patient's condition.
Cancer pain is caused by tumors invading tissues and pressing on nerves. There are three types of pain: nociceptive, inflammatory, and neuropathic. Pain signals travel along nerve pathways from tissues to the spinal cord and brain. Cancer pain management involves detailed assessment, analgesic drugs like opioids, and non-pharmacological treatments. Radiation, chemotherapy, surgery, nerve blocks, and cement injections can help reduce tumor size and pressure causing pain. The goal is comprehensive treatment of physical and psychological distress from cancer.
This document discusses pain management. It defines pain and describes the signs and symptoms of pain. It categorizes pain based on location, intensity, etiology, and duration. Acute pain is short-term while chronic pain lasts over 6 months. Treatment involves pharmacological interventions like NSAIDs, acetaminophen, and opioids as well as non-pharmacological methods such as heat/cold therapy, distraction, and massage. Proper pain assessment and determining the type and severity of pain guides treatment decisions.
This document discusses palliative care, which aims to improve quality of life for patients facing life-threatening illnesses. It defines palliative care as preventing and relieving suffering through early assessment and treatment of pain and other problems. The goals of palliative care are to relieve suffering, treat pain and distressing symptoms, and provide psychological, spiritual and social support. Common symptoms addressed in palliative care are discussed, including pain, nausea, vomiting, dyspnea, constipation and fungating wounds. The importance of psychological care and social support for patients and families is also outlined.
Building on the lecture I gave (and uploaded) "Palliative Care: what every primary care doctor should know" I built this talk. It is geared for 1st year medical students who are learning anatomy, physiology, and perhaps some pharmacology and pathophysiology.
In this talk, I do not explicitly address hospice care - as that was provided in an online chapter for students at UMass. I will later upload another slide set on that topic.
I hope you enjoy it.
FYI- the link to the youtube video: http://www.youtube.com/watch?v=XHtHXGhTIC4
Link to PDF of the slide show: https://files.me.com/s.mak/8fzat6
This document discusses cancer pain management. It notes that 50-90% of oncology inpatients and 35% of outpatients report breakthrough cancer pain. Common causes of cancer pain include bone metastases, visceral metastases, and neuropathic pain. Barriers to effective pain management include clinical, patient-related, and system-related factors as well as racial and ethnic barriers. A thorough pain assessment considers intensity, location, quality, timeline, alleviating factors, and prior medications. Opioids are the mainstay of cancer pain treatment, with short-acting opioids used for breakthrough pain and long-acting for persistent pain.
This document discusses pain and surgery. It begins by outlining a grading system for a class on pain and surgery. It then defines pain and describes it as the first symptom of injury and an indicator of disease processes. The document discusses the physiology of pain, including the four phases of nociception (transduction, transmission, perception, modulation). It describes various types of pain based on duration, source/origin, intensity, and location. Factors affecting pain perception and various non-pharmacologic and pharmacologic pain management strategies are also outlined.
This document provides an overview of pain management including definitions, classifications, clinical assessment, and various treatment options. It begins with defining acute and chronic pain and outlining the pain pathway. It then discusses taking a history, performing an exam, and ordering investigations to clinically assess pain. Finally, it details the WHO analgesic ladder and various pharmacological and non-pharmacological options for controlling pain, such as oral and parenteral analgesics, adjuvant therapies, and managing side effects.
Myasthenia Gravis was first described by Thomas Willis in 1672.
“Myasthenia Gravis” literally means “muscle weakness”.
MG is often called the “snowflake disease” because it differs so much from person to person.
Definition
Myasthenia gravis (MG) is an autoimmune disease that causes chronic, progressive damage of the neuromuscular junction.
The underlying defect is a decrease in the number of available acetylcholine receptor (AChRs) at neuromuscular junctions due to an antibody-mediated autoimmune attack.
Clinical Features
Eye muscles
Drooping of one or both eyelid (Ptosis)
Double vision (diplopia)
Face and throat muscles
Dysarthria
Dysphasia
Problem in chewing
Limited facial expression
Snarling expression
Respiratory symptoms
Weakness of intercostal muscle and diaphragm.
Weakness of pharyngeal muscles
Palate muscle weakness
Nasal voice
Nasal regurgitation
Swallowing may be difficult and regurgitation of food can occur.
Coughing and chocking while drinking
Limb muscle weakness in MG is often proximal and may be asymmetric.
In ~85% o patients, the weakness becomes generalized, affecting the limb muscles as well.
If weakness remains restricted to the extra ocular muscles for 3 years, it is likely that it will not become generalized, and these patients are said to have ocular MG.
This document discusses cognitive perceptual patterns related to pain. It begins with objectives of defining key pain terms, mechanisms of pain perception, classifying pain locations, and factors influencing pain. It then defines pain and related terms like threshold and tolerance. It discusses physiological mechanisms of pain transmission and types of pain classified by duration, location, and origins. Factors influencing pain perception like age, gender, and anxiety are also reviewed. The document concludes with discussing the nursing process for a post-op patient experiencing pain, including assessment, diagnoses, interventions, and evaluation.
This document provides an overview of pain assessment and management. It defines pain, outlines approaches to pain assessment including using scales, and classifications of pain. It then discusses acute pain management, including a morphine pain protocol. It concludes with managing opioid side effects such as nausea, vomiting, and respiratory depression.
1. Pain Management
Aola H. Al Duhaim RN, BScN
Pain Management CNC
AolaH.Duhaim@kfsh.med.sa
Pediatrics
2. The IASP defines Pain as:
“An unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage“
King Fahad Specialist Hospital
Dammam
الـتخـصـصي فـهـد الـمـلـك مــسـتــشـفى
الــدمـام
3. The IASP defines Pain as:
"Pain is whatever the experiencing person says it is and
exists whenever he says it does."
Margo McCaffery
King Fahad Specialist Hospital
Dammam
الـتخـصـصي فـهـد الـمـلـك مــسـتــشـفى
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4. PAIN
▫ Motivates us to withdraw from damaging or
potentially damaging situations.
▫ Protect the damaged body part while it heals, and
avoid those situations in the future.
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6. Children are at Risk of Inadequate Pain
Management
▫ Age-Related Factors
Neurobiological
Physiological
Psychological
▫ Misconceptions
Inadequate analgesia
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7. Developmental Neurobiology
• Sensory fibers are abundant by 20 weeks
• Functional spinal reflex is present by 19 weeks
• Connection to the thalamus are present by 20 weeks
Lee SJ, Ralston H, Drey EA, Partridge J, Rosen MA. Fetal Pain: A Systematic
Multidisciplinary Review of the Evidence.
JAMA. 2005;294(8):947-954
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8. Developmental Neurobiology
• Connection to the subplate neurons are present by 17
weeks e` intensive differentiation by 25 weeks
• Mature thalamocortical projections not present till
29-30 weeks
Lee SJ, Ralston H, Drey EA, Partridge J, Rosen MA. Fetal Pain: A Systematic
Multidisciplinary Review of the Evidence.
JAMA. 2005;294(8):947-954
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9. NOW well accepted by Neuroscientists and Pain Specialists that..
The nervous system is sufficiently developed before birth.
Children experience pain from birth onward
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10. NOW well accepted by Neuroscientists and Pain Specialists that..
Infants and young children may experience a greater
neural response more pain sensation and pain-related
distress
The impact of painful experience on the young
long-term effects can occur
i.e. lowered pain tolerance
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11. Physiological Changes
• CNS (BBB)
• Liver ( Hepatic blood flow Vs.
Immaturity)
• Protein Bindings (Albumin Vs.
AAG)
• Kidney (Protein load ,
Excretion Capability)
• Volume of distribution (water
Vs. Fat compartments)
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13. Cognitive Factors
• Understanding the pain source
• Ability to understand what happen
• Expectation regarding the quality or strength of pain
• Previous experience
• Knowledge of pain control strategies
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14. Behavioral Factors
• Distress responses (child and family)
▫ May initiate, maintain or exacerbate a child’s
pain.
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16. Developmental Stages
Neonate
up to 1 mth
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17. Misconceptions
• The myth that infants and children do not feel pain, or
suffer less from it than adults.
• Lack of routine pain assessment in children.
• Lack of knowledge regarding newer modalities and
proper dosing strategies for the use of analgesics in
children.
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The American Academy of Pediatrics and
the American Pain Society
18. • Fears of respiratory depression or other adverse effects
of analgesic medications.
• The belief that preventing pain in children takes too
much time and effort.
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The American Academy of Pediatrics and
the American Pain Society
Misconceptions
19. Classification of Pain
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20. Sharp & well localized.
Reproduce by touching &
moving the affected area
Somatic1-Nociceptive
Noxious stimulation of
specific pain receptors
Thermal, Mechanical or
Chemical
Deep or Superficial
Stretch, Inflammation &
Ischemia
Poorly localized, cramping,
colicky in nature & may feel like
vague deep ache
21. 2-Non-Nociceptive
within PNS / CNS
Nerve cell dysfunction.
No specific receptors for pain
Neuropathic
AKA: Pinched/ Trapped Nerve
Degeneration, Pressure,
Inflammation ..
it becomes electrically unstable,
firing off signals randomly
Sympathatic
Over-Activity of Sympathetic
Nervous System, and CNS/ PNS
More Commonly After Fractures or
Soft Tissue Injuries
may lead to Complex Regional
Pain Syndrome (CRPS).
Partially Sensitive to:
Paracetamol
NSAIDs
Opioids.
More Sensitive to:
•Anti-Depressants
•Anti-Convulsants
•Anti-Arrhythmics
•NMDAAntagonists
•Topical Capsaicin may be helpful
22. Acute Pain:
• More common
• Begins suddenly
• Sharp in quality
• Serves as a warning of disease/threat
• Caused by ..
▫ Procedures
▫ Surgery
▫ Broken bones
▫ Dental work
▫ Burns or cuts
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23. Chronic Pain:
• Longer than 3-6 months
• Despite the fact that an injury has healed
• Pain signals remain active in the nervous system for
weeks, months, or years.
Such as:
• Cancer pain
• Arthritis pain
• Neurogenic pain (pain resulting from damage to nerves)
• Psychogenic pain (pain not due to past disease or injury or any visible sign
of damage inside)
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24. Breakthrough pain:
A sudden Flare-up of pain that “break through” the
around the clock medication used for persistent pain.
Up to 86% of the patients
3 – 30 min & require different Tx.
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25. Overtreatment
Increased around the clock
medication
Increased side Effects
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26. BTP Medications may not act
quickly enough
Patient suffer pain up to 30 min
or more
Undertreatment
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27. Quick onset BTP medication
Last as long as the BTP (30min)
Easily used
Has manageable Side Effects
PreferredTreatment
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28. Why Should we Treat Pain?
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30. When ..?
• On admission
• After any known pain- producing event
• With each new report of pain
• Routinely at regular intervals
• After intervention
▫ at appropriate time (e.g. 15-30 min P` IV , 1 hr P` PO);
Follow-up assessment is crucial
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31. • To assess pain adequately we must consider..
▫ The developmental stage
▫ Age
▫ Experience
▫ Family Culture/Belief
▫ Language
▫ Severity of Illness
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32. Neonates and Infants
▫ They communicate distress by crying
▫ Should involve the parents
Notice changes in the infant not obvious to the health care
provider
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33. Neonates and Infants
Observational pain scales (unable to verbalize)
These scales, though essential, also respond to distress
from causes other than pain, such as hunger, fear or
anxiety
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34. Preschool and School Age Children
Simple self-report scales using facial expressions or
small objects
To allow more accurately description of their pain
intensity.
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38. Observational Pain Scales
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FLACC 2M – 3 Y
39. King Fahad Specialist Hospital
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2- Poker Chip Scale “pieces of hurt,”
1- Oucher Scale (ethnic versions) well accepted in children over 6 years of age
40. King Fahad Specialist Hospital
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3- Wong-Baker
Faces Scale (free to
use)
(available in 30 languages)4-
5- VAS , NRS
8 years and older
without difficulty
41. Pain Assessment in Pediatrics
Adult Pediatrics
Pain
Fear
Pain receptors are the same in the pediatric patient compared to the adult.
But Children do have increased fear and anxiety.
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42. Pain control must be based on scientific fact, not on
personal beliefs or opinions
Optimal pain management is the right of all patients
and the responsibility of all health professionals
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43. Treatment should include
▫ Pharmacological - Appropriate Multi-Modal
▫ Non-Pharmacological
▫ Sympathetic Nerve Blocks – as needed
▫ Intensive Rehabilitation
Occupational and Physiotherapy.
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45. • Special Considerations in Treating Infants and
Children.
• Although most of the major organ systems in infants
are well developed at birth, their functional maturity
is often delayed.
• In the first months:
▫ These systems rapidly mature similar to adults before 3
months of age.
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46. Multi-Modal Medications
• Inhibition of peripheral inflammatory response
to tissue injury (NSAIDs)
• Blocking the pain receptors (Opioids)
• Neural blockade of transmission of pain
impulses (Regional Tech./Neuraxial blocks)
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47. Multi-Modal Medications
• Prevention of “Central Sensitization” before
tissue injury (Preemptive analgesia)
• Prevention & treatment of anxiety accompanying
acute pain.
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48. Preemptive analgesia
• Treatment that ..
▫ Starts before surgery
▫ Prevent the establishment of Central Sensitization
caused by Injury/Inflammatory responses.
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50. Drugs used for pain management
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
• Acetaminophen
• Opioids
• Adjuvant
• Others
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51. Analgesics (Opioids/L.A)
Most are conjugated in the liver.
Newborns, and especially premature infants, have
delayed maturation of the enzyme systems involved
in drug conjugation
▫ Several of these hepatic enzyme systems mature at varying
rates over the first 6 months of life.
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52. Analgesics (Opioids/L.A)
Glomerular filtration rates :
▫ Diminished in the first week of life, especially in premature
infants
▫ but sufficiently mature to clear medications and metabolites
by 2 weeks of age.
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53. Analgesics (Opioids/L.A)
Newborns
have a higher percentage of body weight as water and
less as fat
Water soluble drugs often have larger volumes of
distribution.
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54. Analgesics (Opioids/L.A)
Newborns
• Have reduced plasma concentrations of both albumin
and alpha-1 acid glycoprotein
may lead to higher concentrations of unbound drug (active), and
thereby greater drug effect or drug toxicity.
• Have diminished ventilatory responses to hypoxemia
and hypercarbia - especially premature infants
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55. Acetaminophen
• Excellent safe profile and lack of significant side
effects
• commonly used
• mild to moderate pain,
• often combined with opioid (for more severe pain)
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56. Acetaminophen
• Can results in Hepatotoxicity
• Infants and children produce high levels of GSH as a
part of hepatic growth may provide some
protection
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57. Acetaminophen
• Still acetaminophen toxicity are highest in pediatric
patients.
▫ Analysis of Poison Control Center data, FDA adverse
event reports, and clinical trial reports indicate that
therapeutic doses of <75 mg/kg daily are safe with
respect to hepatotoxicity.
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58. NSAIDs
• Pharmacodynamics and pharmacokinetics are not
much different than in adults.
• Potential for GI, renal and other toxicities exist
but less than in adults.
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60. Patient Controlled Analgesia
• Widely used for postoperative pain relief
• Appropriate preoperative teaching and
encouragement
• As young as 6 to 7 years of age can independently
use the PCA
• 4 and 6, however, require encouragement from their
parents and nurses
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61. Local Anesthetics and Regional Anesthesia
• Topical Anesthetics (EMLA)
• provide pain relief prior to needle-stick
procedures
• requires 30 to 60 minutes to become fully
effective after application.
• must be applied in a thick layer
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62. EMLA
• Clinical trials have shown effectiveness of EMLA in
reducing the pain or distress of a number of common
pediatric procedures including:
▫ venous cannulation
▫ Venipuncture
▫ lumbar puncture,
▫ Circumcision
▫ urethral meatotomy
▫ Immunizations
▫ dermatologic procedures … etc.
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64. Comfort Methods:
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Repositioning
Singing
or soft music
Gentle stroking
Rocking with the child
in a rocking chair
65. Swaddling
Comfort Methods:
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Watching a movie
Reading a book
Other methods used at home
to comfort the child
66. Psychological strategies:
For children undergoing repeated painful procedures,
cognitive-behavioral therapy
▫ decrease anxiety and distress
▫ help children master a distressing situation.
▫ take time to learn and master
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67. Psychological strategies:
• Distraction techniques
▫ divert attention away from painful stimuli
• positive incentive techniques
▫ provide a small reward (e.g., stickers or prizes)
Decrease anxiety but not adequate as the sole means of
pain relief.
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68. Persistent Pain in Children
• Children with chronic medical disease can
experience:
▫ a significant amount of pain associated with both their
underlying disease and the procedures that are performed to
treat it.
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69. Persistent Pain in Children
• Children with chronic medical disease can
experience:
▫ They deserve not only access to adequate pain medication,
but also psychological support to help them continue to
learn and grow as they should.
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70. SUMMARY
• The pediatric nervous system is fully developed and
able to respond to Nociceptive stimuli even in pre-
term neonates
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71. SUMMARY
• Pain can have lasting physiological and
developmental consequences if not appropriately
managed
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72. SUMMARY
• Regular pain assessment is fundamental to good pain
management but is often poorly performed
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73. SUMMARY
• A variety of pain assessment tools are available and
should be utilized according to a patient’s age and
developmental stage
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74. SUMMARY
• Multi-modal therapy is appropriate for managing all
forms of pediatric pain and should utilize
combinations of local anesthetic, paracetamol,
NSAIDs and opioids as appropriate
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75. SUMMARY
• Adequate monitoring, safety equipment and
resuscitation skills are needed to safely manage
patients requiring combinations of sedation and
analgesia for painful procedures
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76. SUMMARY
• The pharmacokinetic and pharmacodynamic profile
of commonly used analgesics can be variable
depending on the age and development
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77. THANK YOU
Aola H. Al Duhaim RN, BScN
Pain Management CNC
AolaH.Duhaim@kfsh.med.sa
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Editor's Notes
1- Tissue damage
2- Activation of the PNS
3- Activation of CNS @ the Spinal cord level
4- Transmission of Pain signal to the brain and reaction
The blood–brain barrier (BBB) is a highly selective permeability barrier that separates the circulating blood from the brain extracellular fluid (BECF) in the central nervous system (CNS). The blood–brain barrier is formed by capillary endothelial cells, which are connected by tight junctions with an extremely high electrical resistivity of at least 0.1 Ω⋅m.[1] The blood–brain barrier allows the passage of water, some gases, and lipid soluble molecules by passive diffusion, as well as the selective transport of molecules such as glucose and amino acids that are crucial to neural function. On the other hand, the blood–brain barrier may prevent the entry of lipophilic, potentialneurotoxins by way of an active transport mechanism mediated by P-glycoprotein. Astrocytes are necessary to create the blood–brain barrier. A small number of regions in the brain, including the circumventricular organs (CVOs), do not have a blood–brain barrier.
Neonates and infants have a lower AAG concentration in serum as compared with adults; therefore, their free fraction of local anaesthetics is increased accordingly. This has important clinical implications since, at least at steady state, the toxic effects of local anaesthetics are directly related to the free (unbound) drug concentration
After injection into the epidural space, absorption into the bloodstream follows a biphasic process. The buffering properties of the epidural space are important and prevent a rapid rise in concentration. In infants and children, the epidural space seems to protect patients in a similar manner. Moreover, it has been observed that the peak plasma concentration (Cmax) of ropivacaine is delayed in infants and children when compared with adults. The time to Cmax decreases from 90–120 minutes in infants aged less than 6 months to 30 minutes in children aged more than 8 years. This delay in Cmax may also be related to the lower clearance observed in younger patients. Local anaesthetics are metabolised by cytochrome P450 (CYP). The main CYP isoforms involved are CYP3A4 for lidocaine and bupivacaine and CYP1A2 for ropivacaine. CYP3A4 is not mature at birth but is partly replaced by CYP3A7. The intrinsic clearance of bupivacaine is only one-third of that in adults at 1 month of age, and two-thirds at 6 months. CYP1A2 is not fully mature before the age of 3 years. Indeed, the clearance of ropivacaine does not reach its maximum before the age of 5 years. However, at birth this clearance is not as low as expected, and ropivacaine may be used even in younger patients.
NMDA Antagonists are a class of anesthetics that work to antagonize, or inhibit the action of, the N-Methyl-D-aspartate receptor (NMDAR). They are used as anesthetics for animals and for humans; the state of anesthesia they induce is referred to as dissociative anesthesia. There is evidence that NMDA receptor antagonists can cause a certain type of neurotoxicity or brain damage referred to as Olney's Lesions in rodents, although such damage has never been conclusively observed in primates likehumans. Recent research conducted on primates suggests that, while very consistent and long-term ketamine use may be neurotoxic, acute use is not.[1][2]
Several synthetic opioids function additionally as NMDAR-antagonists, such as pethidine, methadone, dextropropoxyphene, tramadol and ketobemidone.
Some NMDA receptor antagonists, such as ketamine, dextromethorphan (DXM), phencyclidine (PCP), Methoxetamine (MXE), and nitrous oxide (N2O), are popular recreational drugs used for their dissociative, hallucinogenic, and euphoriant properties. When used recreationally, they are classified as dissociative drugs.
Capsaicin كاب ساي سين
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