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Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis
BACKGROUND: Sufficient analgesia is an obligation, but oligoanalgesia (NRS> 3) is frequently observed prehospitally. Potent analgesics may cause severe adverse events. Thus, analgesia in the helicopter emergency medical service (HEMS) setting is challenging. Adequacy, efficacy and administration...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852148/ https://www.ncbi.nlm.nih.gov/pubmed/33526048 http://dx.doi.org/10.1186/s13049-021-00839-9 |
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author | Rugg, Christopher Woyke, Simon Voelckel, Wolfgang Paal, Peter Ströhle, Mathias |
author_facet | Rugg, Christopher Woyke, Simon Voelckel, Wolfgang Paal, Peter Ströhle, Mathias |
author_sort | Rugg, Christopher |
collection | PubMed |
description | BACKGROUND: Sufficient analgesia is an obligation, but oligoanalgesia (NRS> 3) is frequently observed prehospitally. Potent analgesics may cause severe adverse events. Thus, analgesia in the helicopter emergency medical service (HEMS) setting is challenging. Adequacy, efficacy and administration safety of potent analgesics pertaining to injured patients in HEMS were analysed. METHODS: Observational study evaluating data from 14 year-round physician-staffed helicopter bases in Austria in a 12-year timeframe. RESULTS: Overall, 47,985 (34.3%) patients received analgesics, 26,059 of whom were adult patients, injured and not mechanically ventilated on site. Main drugs administered were opioids (n=20,051; 76.9%), esketamine (n=9082; 34.9%), metamizole (n=798; 3.1%) and NSAIDs (n=483; 1.9%). Monotherapy with opioids or esketamine was the most common regimen (n=21,743; 83.4%), while opioids together with esketamine (n= 3591; 13.8%) or metamizole (n=369; 1.4%) were the most common combinations. Females received opioids less frequently than did males (n=6038; 74.5% vs. n=14,013; 78.1%; p< 0.001). Pain relief was often sufficient (> 95%), but females more often had moderate to severe pain on arrival in hospital (n=34; 5.0% vs. n=59; 3.2%; p=0.043). Administration of potent analgesics was safe, as indicated by MEES, SpO(2) and respiratory rates. On 10% of all missions, clinical patient assessment was deemed sufficient by HEMS physicians and monitoring was spared. CONCLUSIONS: Opioids and esketamine alone or in combination were the analgesics of choice in physician-staffed HEMS in Austria. Analgesia was often sufficient, but females more than males suffered from oligoanalgesia on hospital arrival. Administration safety was high, justifying liberal use of potent analgesics in physician-staffed HEMS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13049-021-00839-9. |
format | Online Article Text |
id | pubmed-7852148 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-78521482021-02-03 Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis Rugg, Christopher Woyke, Simon Voelckel, Wolfgang Paal, Peter Ströhle, Mathias Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Sufficient analgesia is an obligation, but oligoanalgesia (NRS> 3) is frequently observed prehospitally. Potent analgesics may cause severe adverse events. Thus, analgesia in the helicopter emergency medical service (HEMS) setting is challenging. Adequacy, efficacy and administration safety of potent analgesics pertaining to injured patients in HEMS were analysed. METHODS: Observational study evaluating data from 14 year-round physician-staffed helicopter bases in Austria in a 12-year timeframe. RESULTS: Overall, 47,985 (34.3%) patients received analgesics, 26,059 of whom were adult patients, injured and not mechanically ventilated on site. Main drugs administered were opioids (n=20,051; 76.9%), esketamine (n=9082; 34.9%), metamizole (n=798; 3.1%) and NSAIDs (n=483; 1.9%). Monotherapy with opioids or esketamine was the most common regimen (n=21,743; 83.4%), while opioids together with esketamine (n= 3591; 13.8%) or metamizole (n=369; 1.4%) were the most common combinations. Females received opioids less frequently than did males (n=6038; 74.5% vs. n=14,013; 78.1%; p< 0.001). Pain relief was often sufficient (> 95%), but females more often had moderate to severe pain on arrival in hospital (n=34; 5.0% vs. n=59; 3.2%; p=0.043). Administration of potent analgesics was safe, as indicated by MEES, SpO(2) and respiratory rates. On 10% of all missions, clinical patient assessment was deemed sufficient by HEMS physicians and monitoring was spared. CONCLUSIONS: Opioids and esketamine alone or in combination were the analgesics of choice in physician-staffed HEMS in Austria. Analgesia was often sufficient, but females more than males suffered from oligoanalgesia on hospital arrival. Administration safety was high, justifying liberal use of potent analgesics in physician-staffed HEMS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13049-021-00839-9. BioMed Central 2021-02-01 /pmc/articles/PMC7852148/ /pubmed/33526048 http://dx.doi.org/10.1186/s13049-021-00839-9 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Original Research Rugg, Christopher Woyke, Simon Voelckel, Wolfgang Paal, Peter Ströhle, Mathias Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title | Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_full | Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_fullStr | Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_full_unstemmed | Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_short | Analgesia in adult trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis |
title_sort | analgesia in adult trauma patients in physician-staffed austrian helicopter rescue: a 12-year registry analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852148/ https://www.ncbi.nlm.nih.gov/pubmed/33526048 http://dx.doi.org/10.1186/s13049-021-00839-9 |
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