How to Manage Pain in the ER
Simply asking the question, "Do you want more pain medication?" resulted in satisfactory pain control in 99 percent of emergency department patients participating in the study, the researchers say. The findings are published in Annals of Emergency Medicine.
"Pain perception is highly subjective and not necessarily correlated to pain scores. Our pain protocol is a departure from the more traditional ways of assessing pain relief, which typically use the visual analogue scale or the numerical rating scale," says Andrew Chang, MD, MS of the Department of Emergency Medicine at Montefiore Medical Center in Bronx, N.Y. and one of the study's authors.
"Our simple and easy to remember '1 + 1 + 1 + 1' protocol holds promise for safely providing adequate pain relief to patients with acute severe pain," Dr. Chang points out.
For the study, Dr. Chang and his colleagues provided 1 milligram of intravenous (IV) hydromorphone to adult patients reporting acute, severe pain. Thirty minutes later, the patient was asked, "Do you want more pain medication?" The patient was then asked the same question at 30-minute intervals and given an additional 1 milligram IV hydromorphone each time he/she answered "yes."
The study's primary endpoint was the proportion of patients achieving satisfactory pain control, defined as declining additional pain medication on 1 or more occasions.
Of the 207 patients enrolled in the study, 114 received 1 milligram of hydromorphone (the initial dose), 78 received 2 milligrams, nine received 3 milligrams and six received 4 milligrams. No adverse events were associated with amount of hydromorphone received.
According to researchers, all but two of the patients achieved satisfactory pain control within 2 to 4 hours (the study period's duration). Almost all of the patients were satisfied with their pain treatment: 67 percent reported being very satisfied and 29 percent reported being satisfied.
"The crowded conditions in most emergency departments in the U.S. are not conducive to fully individualised pain treatment," notes Dr. Chang. "Our use of a non-numerical, simple yes/no question offers patients the ability to decide for themselves whether their pain is adequately controlled and allows them to balance pain relief against medication side effects such as nausea and drowsiness."
Source: American College of Emergency Physicians
Image credit: Flickr.com
Published on : Tue, 16 Jun 2015
Print as PDF
The HAMILTON-C6 represents a new Generation of high-end ventilators. The combination of modularity, ease of use, mobility, and advanced features allows you to individualize your patient's ventilation therapy: - State-of-the-art ventilation modes for...
Features SV 300 is a state-of-the-art ventilator that’s simple to configure, easy to operate and versatile in use. It equips with extensive ventilation modes that can treats pediatric and adult patients with all acuity levels at ICUs and Intermediate...
Medos customized tubing sets have been individually designed, so that all customer requirements, depending on application and need can be realized. Furthermore tubing sets can be refined by rheoparin or x.eed coating.
The fully-automated Accelerate Pheno™ system is designed to eliminate the lengthy culture and sample preparation steps required for most sample types prior to antimicrobial susceptibility testing. In addition, it hosts proprietary molecular identification...
Q-NRG is the first Indirect Calorimeter specifically intended for the measurement of Resting Energy Expenditure (REE) in patients who are mechanically ventilated or spontaneously breathing and for healthy subjects. Q-NRG is a unique product, resulting...