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The Pain Management of Trauma Patients in the Emergency Department

The vast majority of injured patients suffer from pain. Systematic assessment of pain on admission to the emergency department (ED) is a cornerstone of translating the best treatment strategies for patient care into practice. Pain must be measured with severity scales that are validated in clinical...

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Autores principales: Fabbri, Andrea, Voza, Antonio, Riccardi, Alessandro, Serra, Sossio, Iaco, Fabio De
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179230/
https://www.ncbi.nlm.nih.gov/pubmed/37176729
http://dx.doi.org/10.3390/jcm12093289
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author Fabbri, Andrea
Voza, Antonio
Riccardi, Alessandro
Serra, Sossio
Iaco, Fabio De
author_facet Fabbri, Andrea
Voza, Antonio
Riccardi, Alessandro
Serra, Sossio
Iaco, Fabio De
author_sort Fabbri, Andrea
collection PubMed
description The vast majority of injured patients suffer from pain. Systematic assessment of pain on admission to the emergency department (ED) is a cornerstone of translating the best treatment strategies for patient care into practice. Pain must be measured with severity scales that are validated in clinical practice, including for specific populations (such as children and older adults). Although primary care ED of trauma patients focuses on resuscitation, diagnosis and treatment, pain assessment and management remains a critical element as professionals are not prepared to provide effective and early therapy. To date, most EDs have pain assessment and management protocols that take into account the patient’s hemodynamic status and clinical condition and give preference to non-pharmacological approaches where possible. When selecting medications, the focus is on those that are least disruptive to hemodynamic status. Pain relief may still be necessary in hemodynamically unstable patients, but caution should be exercised, especially when using opioids, as absorption may be impaired or shock may be exacerbated. The analgesic dose of ketamine is certainly an attractive option. Fentanyl is clearly superior to other opioids in initial resuscitation and treatment as it has minimal effects on hemodynamic status and does not cause central nervous system depression. Inhaled analgesia techniques and ultrasound-guided nerve blocks are also increasingly effective solutions. A multimodal pain approach, which involves the use of two or more drugs with different mechanisms of action, plays an important role in the relief of trauma pain. All EDs must have policies and promote the adoption of procedures that use multimodal strategies for effective pain management in all injured patients.
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spelling pubmed-101792302023-05-13 The Pain Management of Trauma Patients in the Emergency Department Fabbri, Andrea Voza, Antonio Riccardi, Alessandro Serra, Sossio Iaco, Fabio De J Clin Med Review The vast majority of injured patients suffer from pain. Systematic assessment of pain on admission to the emergency department (ED) is a cornerstone of translating the best treatment strategies for patient care into practice. Pain must be measured with severity scales that are validated in clinical practice, including for specific populations (such as children and older adults). Although primary care ED of trauma patients focuses on resuscitation, diagnosis and treatment, pain assessment and management remains a critical element as professionals are not prepared to provide effective and early therapy. To date, most EDs have pain assessment and management protocols that take into account the patient’s hemodynamic status and clinical condition and give preference to non-pharmacological approaches where possible. When selecting medications, the focus is on those that are least disruptive to hemodynamic status. Pain relief may still be necessary in hemodynamically unstable patients, but caution should be exercised, especially when using opioids, as absorption may be impaired or shock may be exacerbated. The analgesic dose of ketamine is certainly an attractive option. Fentanyl is clearly superior to other opioids in initial resuscitation and treatment as it has minimal effects on hemodynamic status and does not cause central nervous system depression. Inhaled analgesia techniques and ultrasound-guided nerve blocks are also increasingly effective solutions. A multimodal pain approach, which involves the use of two or more drugs with different mechanisms of action, plays an important role in the relief of trauma pain. All EDs must have policies and promote the adoption of procedures that use multimodal strategies for effective pain management in all injured patients. MDPI 2023-05-05 /pmc/articles/PMC10179230/ /pubmed/37176729 http://dx.doi.org/10.3390/jcm12093289 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Fabbri, Andrea
Voza, Antonio
Riccardi, Alessandro
Serra, Sossio
Iaco, Fabio De
The Pain Management of Trauma Patients in the Emergency Department
title The Pain Management of Trauma Patients in the Emergency Department
title_full The Pain Management of Trauma Patients in the Emergency Department
title_fullStr The Pain Management of Trauma Patients in the Emergency Department
title_full_unstemmed The Pain Management of Trauma Patients in the Emergency Department
title_short The Pain Management of Trauma Patients in the Emergency Department
title_sort pain management of trauma patients in the emergency department
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179230/
https://www.ncbi.nlm.nih.gov/pubmed/37176729
http://dx.doi.org/10.3390/jcm12093289
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