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A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town

INTRODUCTION: Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. METHODS: A retrospective, descriptive surv...

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Autores principales: Matthews, Ryan, McCaul, Michael, Smith, Wayne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: African Federation for Emergency Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234150/
https://www.ncbi.nlm.nih.gov/pubmed/30456102
http://dx.doi.org/10.1016/j.afjem.2017.01.002
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author Matthews, Ryan
McCaul, Michael
Smith, Wayne
author_facet Matthews, Ryan
McCaul, Michael
Smith, Wayne
author_sort Matthews, Ryan
collection PubMed
description INTRODUCTION: Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. METHODS: A retrospective, descriptive survey was undertaken of analgesic drug administration by advanced life support paramedics. Patient care records generated in the City of Cape Town during an 11-month period containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. RESULTS: A total of 530 patient care records were included (n = 530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. A total of 5 mg or less of morphine was administered in 278 (75%, 95% CI 70–79) cases, with the median dose being 4 mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administrations, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate administrations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). DISCUSSION: Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain is an important reason for drug administration in acute pre-hospital pain. Multimodal analgesia is not a feature of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative.
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spelling pubmed-62341502018-11-19 A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town Matthews, Ryan McCaul, Michael Smith, Wayne Afr J Emerg Med Original Research INTRODUCTION: Emergency Medical Services are ideally placed to provide relief of acute pain and discomfort. The objectives of this study were to describe pre-hospital pain management practices by Emergency Medical Services in the Western Cape, South Africa. METHODS: A retrospective, descriptive survey was undertaken of analgesic drug administration by advanced life support paramedics. Patient care records generated in the City of Cape Town during an 11-month period containing administrations of morphine, ketamine, nitrates and 50% nitrous oxide/oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. RESULTS: A total of 530 patient care records were included (n = 530). Morphine was administered in 371 (70%, 95% CI 66–74) cases, nitrates in 197 (37%, 95% CI 33–41) and ketamine in 9 (1.7%, 95% CI 1–3) cases. A total of 5 mg or less of morphine was administered in 278 (75%, 95% CI 70–79) cases, with the median dose being 4 mg (IQR 3–6). Single doses were administered to 268 (72.2%, 95% CI 67–77) morphine administrations, five (56%, 95% CI 21–86) ketamine administrations and 161 (82%, 95% CI 76–87) of nitrate administrations. Chest pain was the reason for pain management in 226 (43%) cases. Advanced Life Support Providers had a median experience level of two years (IQR 2–4). DISCUSSION: Pre-hospital acute pain management in the Western Cape does not appear to conform to best practice as Advanced Life Support providers in the Western Cape use low doses of morphine. Chest pain is an important reason for drug administration in acute pre-hospital pain. Multimodal analgesia is not a feature of care in this pre-hospital service. The development of a Clinical Practice Guideline for and training in pre-hospital pain should be viewed as imperative. African Federation for Emergency Medicine 2017-03 2017-01-28 /pmc/articles/PMC6234150/ /pubmed/30456102 http://dx.doi.org/10.1016/j.afjem.2017.01.002 Text en © 2017 African Federation for Emergency Medicine. Publishing services provided by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Matthews, Ryan
McCaul, Michael
Smith, Wayne
A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
title A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
title_full A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
title_fullStr A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
title_full_unstemmed A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
title_short A description of pharmacological analgesia administration by public sector advanced life support paramedics in the City of Cape Town
title_sort description of pharmacological analgesia administration by public sector advanced life support paramedics in the city of cape town
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234150/
https://www.ncbi.nlm.nih.gov/pubmed/30456102
http://dx.doi.org/10.1016/j.afjem.2017.01.002
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