PAIN MANAGEMENT

IN EMERGENCY
N.MARGARITA REHATTA
DEPARTMENT OF ANESTHESIOLOGY AND INTENSIVE THERAPY
FACULTY OF MEDICINE ,UNIVERSITAS AIRLANGGA
DR SUTOMO HOSPITAL

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• OUT LINE
- The need of early and adequate treatment
- Emergency Setting
- Consideration
- Mass Disaster ?

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EARLY AND ADEQUATE PAIN MANAGEMENT

• Prevent suffering  humanitarian action

• Reduced stress reaction
- Biologic
- Organ dysfunction

Decrease morbidity

• Decrease change in CNS responsible for

chronic pain
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 Pain is a distressing experience associate with
actual or potential tissue damage with
sensory, emotional ,cognitive and social
components

The Ethical Principles

to provide pain management and comfort all
patients
including those – unable to speak for them
self
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 EMERGENCY SETTING
Vital function resuscitation /
stabilization

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 Inadequately treating pain
• Lack of of documentation and reassessment of pain
• Poor communication between clinician and patient
(language/ cultural)
• Concern of masking symptoms, one of the most cited
reasons is the concern that analgesics, particularly
opioid , mask symptoms of a surgical abdomen

RCT
• Pain continued + in adequately treated palpation on
physical examination ( Kim M, Strait R. Acad Emerg Med. 2002)
• And the obturator sign, rovsing, and pain upon jumping
• (Yong Y et al Chin Med J.2010;123(2):142–5.
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 Periodically
Five vital sign evaluation
Blood pressure
Pulse rate
Respiratory rate and
Temperature,
Pain
Numeric Rating Scale (NRS)

Evaluate effectiveness
of ED pain management
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 • Improvements in rapid pain assessment and in evaluation of
non communicative populations /language barrier may result
in a better estimation of which patients require analgesia and
how much pain is present.
• In the ED acute pain represents a huge spectrum of disease
processes.
• Anxiety may be under recognized and undertreated in
stressed patient . Patients reporting severe anxiety were less
likely to report satisfaction with the treatment of their pain,
despite higher rates of analgesic administration.

• Pain perception in elderly patients, >/=65 years old, was found to be lower than
in patients <65 years old (median 1 vs. 6.5, respectively; p = .02). Anxiety was
found to be related to higher pain perception after adjusting for confounding
variables (13.8 vs. 7.6, respectively; adjusted p = .022). Gender, age, and anxiety,
but not depression, are possible factors related to pain perception in the
emergency setting. Further studies are needed to reveal the factors affecting
pain perception and the complex relationship between psychiatric status and
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pain.
• PMID: 19041612 DOI: 10.1016/j.pmn.2008.06.002

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ACUTE PAIN SERVICE
Guidelines

Asses pain routinely

Asses option for pain control individualized
Provide instruction in simple – cognitive behavioral
technique
Treat as early as possible
Use multimodal approach ( Pharmacological and
non Pharmacological)
Select treatment according to acute clinical setting
 Promptly modify according to patient response
 Provide continuity
TO BE CONSIDER IN PLANNING THE MANAGEMENT
• Underlying result of the trauma ( Unstable Fracture
,Pneumo hemato thorax)
• Possible serious complication ( impending shock ,
brain trauma)
• Anatomic derangement
• Pain level – severity of the injury
• Psychological condition
• Time Limit

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WHY PAIN THERAPY DO NOT PERFORM WELL IN ED?

1.Inadequate documentation of patients’ pain

experience both at presentation and throughout
their ED treatment

2.Inadequate doses of analgesic and administered by

inappropriate routes

3. Pain management not being seen as a high priority.

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MULTIMODAL APPROACH
NON PHARMACOLOGIC APPROACH

PHARMACOLOGIC APPROACH
Local
Systemic
Nerve Block

THE ANALGESIA BALANCE

NON PHARMACOLOGIC APPROACH

Reassurance ,Emphaty and Information

Treating underlying result of injury

 relieving hemopneumothorax
 stabilizing an unstable fracture
 Pain management in mass disaster ?

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Indonesia earthquake, tsunami death toll tops
400, hundreds more injured

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By Nicole Chavez and Mochammad Andri, CNN
Updated 0827 GMT (1627 HKT) September 30, 2018
• Catatan tambahan

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 Stetoskop
Artificial
Intellegence

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• SEMOGA BERMANFAAT

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