prehospital analgesia dr david teubner 20/7/5
DESCRIPTION
Types of pain Lots of different calssifications Acute vs chronicTRANSCRIPT
![Page 1: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/1.jpg)
Prehospital Analgesia
Dr David Teubner 20/7/5http://www.davidteubner.com/work_talks.htm
![Page 2: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/2.jpg)
What is pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
IASP 1986
![Page 3: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/3.jpg)
Types of pain
• Lots of different calssifications• Acute vs chronic
![Page 4: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/4.jpg)
Acute pain
• Cause is known• Temporary (< 6 weeks)• Located in area of trauma• Resolves spontaneously
![Page 5: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/5.jpg)
Chronic pain
• Untreated pain may lead to neuronal changes which alter pain sensation and lead to chronic pain
![Page 6: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/6.jpg)
History of prehospital analgesia
• US army ambulances in the 1860’s carried brandy for pain relief
• Even today there is very little scientific evidence for any of the techniques used
![Page 7: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/7.jpg)
Analgesia myths
• No diagnosis = no analgesia• Analgesia masks clinical signs• We do a good job in providing analgesia• Any dose of morphine will provide pain
relief• Analgesia causes dependence• Analgesia causes adverse events
![Page 8: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/8.jpg)
Time to analgesia
• Oligoanalgesia well recognised in EDs• Frequent source of patient complaint
![Page 9: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/9.jpg)
Assessment of pain
• Pain is unique to the individual, it is influenced by• Age• Race• Gender• Culture• Emotional/cognitive state• Prior experience
![Page 10: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/10.jpg)
Measurement of pain
• Visual analogue scales• Numerical rating scale• Verbal or adjective rating scale
(VRS/ARS): none, mild, moderate, severe, or unbearable.
![Page 11: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/11.jpg)
Management of pain
• Non pharmacological• Drugs
– Methoxyflurane– Morphine
![Page 12: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/12.jpg)
Non–pharmacological management
• Management of the underlying condition– Splinting fractures– Positioning
• Reassurance• Others
– Cognitive (guided imagery, music, distraction)– Behavioural (relaxation, breathing,
biofeedback)
![Page 13: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/13.jpg)
![Page 14: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/14.jpg)
Morphine history• Naturally derived from the opium poppy –
Papaver somniferum• Opium first used in about 4000 BC• First medical use in 200 BC• In the 16th century Paracelcus called it
laudanum (from latin laudare – to praise)• First isolated in 1803 by Serturner who called it
morphia.• Now called morphine instead as most plant alkaloids
end in “-ine”
![Page 15: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/15.jpg)
Morphine• Narcotic Opiod analgesic• Bind to Opiod receptors to cause analgesia,
euphoria, sedation, and respiratory/physical depression
• Stimulates emetic chemoreceptors.• Peripheral vasodilitation and inhibition of
baroreceptors.• Histamine release is common• 2-20 mg IV
Paeds 0.1-0.2 mg/kg
![Page 16: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/16.jpg)
Morphine indications
• Pain– Musculoskeletal– Chest– Abdominal
![Page 17: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/17.jpg)
Contraindications
Known allergy
![Page 18: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/18.jpg)
Morphine - precautions
• Prepare to manage hypotension and respiratory depression-use w/ caution in COPD and Asthma
• Inhibits peristalsis• Rapid injection increases incidence of
adverse reactions• Headache
![Page 19: Prehospital Analgesia Dr David Teubner 20/7/5](https://reader035.vdocuments.site/reader035/viewer/2022062219/5a4d1b0e7f8b9ab05998d834/html5/thumbnails/19.jpg)
Questions?