Evaluation of pain management in medical transfer of trauma patients by air

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 776-783
Author(s):  
Isabelle H. Miles ◽  
Russell D. MacDonald ◽  
Sean W. Moore ◽  
James Ducharme ◽  
Christian Vaillancourt
Keyword(s):  
Pain Management ◽  
Adverse Events ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Trauma Centre ◽  
Air Transport ◽  
Future Research ◽  
Trauma Patients ◽  
Numerical Rating ◽  
Standard Deviation Range

ABSTRACTObjectivesWith regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients.MethodsWe conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency. Patients were included if they were ≥18 years old and underwent air transport to a trauma centre, and excluded if they were Glasgow Coma Scale score <14, intubated, or accompanied by a physician or nurse. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment via 11-point numerical rating scale, patterns of analgesia administration, and analgesia-related adverse events. Results were reported as mean ± standard deviation, [range], (percentage).ResultsWe included 372 patients: 47.0 years old; 262 males; 361 blunt injuries. Transport duration was 82.4 ± 46.3 minutes. In 232 (62.4%) patients who received analgesia, baseline numerical rating scale was 5.9 ± 2.5. Fentanyl was most commonly administered at 44.3 [25–60] mcg. Numerical rating scale after first analgesia dose decreased by 1.1 [-2–7]. Thereafter, 171 (73.7%) patients received 2.4 [1-18] additional doses. While 44 (23.4%) patients had no change in numerical rating scale after first analgesia dose, subsequent doses resulted in no change in numerical rating scale in over 65% of patients. There were 43 adverse events recorded, with nausea the most commonly reported (39.5%).ConclusionsInitial and subsequent dose(s) of analgesic had minimal effect on pain as assessed via numerical rating scale, likely due in part to inadequate dosing. Future research is required to determine and address the barriers to proper analgesia.

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

scholarly journals Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

2022 ◽  
Vol 9 ◽  
pp. 237437352110496
Author(s):  
Jenni Hämäläinen ◽  
Tarja Kvist ◽  
Päivi Kankkunen
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Numerical Rating ◽  
Emergency Department Patients ◽  
Pain At Rest ◽  
Patients Perspective

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

scholarly journals Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study

Rheumatology ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 1906-1915
Author(s):  
Sara Muller ◽  
Rebecca Whittle ◽  
Samantha L Hider ◽  
John Belcher ◽  
Toby Helliwell ◽  
...  
Keyword(s):  
Latent Class ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Postal Questionnaire ◽  
The Other ◽  
Future Research ◽  
Partial Recovery ◽  
Numerical Rating ◽  
Sustained Recovery ◽  
Over Time

Abstract Objectives To investigate potential subgroups of primary care–diagnosed patients with PMR based on self-reported pain and stiffness severity over time. Methods A total of 652 people with an incident PMR diagnosis were recruited from English general practices and completed a baseline postal questionnaire. They were followed up with a further six questionnaires over a 2 year period. A total of 446 people completed the 2 year follow-up. Pain and stiffness were reported on a 0–10 numerical rating scale. Latent class growth analysis was used to estimate the joint trajectories of pain and stiffness over time. A combination of statistical and clinical considerations was used to choose the number of clusters. Characteristics of the classes were described. Results Five clusters were identified. One cluster represented the profile of ‘classical’ PMR symptoms and one represented sustained symptoms that may not be PMR. The other three clusters displayed a partial recovery, a recovery followed by worsening and a slow, but sustained recovery. Those displaying classical PMR symptoms were in better overall health at diagnosis than the other groups. Conclusion PMR is a heterogeneous condition, with a number of phenotypes. The spectrum of presentation, as well as varying responses to treatment, may be related to underlying health status at diagnosis. Future research should seek to stratify patients at diagnosis to identify those likely to have a poor recovery and in need of an alternative treatment pathway. Clinicians should be aware of the different experiences of patients and monitor symptoms closely, even where there is initial improvement.

scholarly journals Prospective analysis of post-operative pain management in elective laparotomies in a tertiary care centre

2021 ◽  
Author(s):  
Nithya T. ◽  
S. Rajagopalan
Keyword(s):  
Pain Management ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Open Cholecystectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Tertiary Care Centre ◽  
Numerical Rating ◽  
Management Method

Background: The study was conducted to record the drug used for postoperative pain in elective laparotomies and to determine the effectiveness of multimodal analgesics used.Methods: A prospective observational study for a period of 15 months from March 2019 to May 2020 in 140 patients who underwent elective laparotomies from the department of general surgery Rajarajeswari medical college and hospital (tertiary care center).Results: A total of 140 patients were included among which 58 (41.4%) were female and 82 (58.6%) were male patients. The 20 different types of surgeries were recorded. In our study the most common surgery performed was open appendectomy followed by open cholecystectomy. Most common mode of analgesia used was combined analgesia. Opioids, NSAIDS (non-steroidal anti-inflammatory drugs), epidural and transdermal patch was used. NRS (numerical rating scale) score was recorded for all 140 patients on postoperative days 1, 2 and 3.Conclusions: Combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

scholarly journals Acupuncture for Cancer Related Pain: Protocol for a Pragmatic Randomised Wait-List Controlled Trial

2020 ◽  
Vol 19 ◽  
pp. 153473542097657
Author(s):  
Qi Zhao ◽  
Suyang Zheng ◽  
Geoff P. Delaney ◽  
Eugene Moylan ◽  
Meera R. Agar ◽  
...  
Keyword(s):  
Adverse Events ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Post Treatment ◽  
Local Health ◽  
Wait List ◽  
Clinical Trial Registry ◽  
Numerical Rating ◽  
Randomised Controlled

Background: Acupuncture has been proved effective for cancer related pain (CRP) in China, America and some other countries. However, there is relative lack of evidence to support the use of acupuncture for CRP in Australia. Objectives: To assess the effectiveness and safety of acupuncture for management of CRP in a real-world setting and to understand cancer patients’ experience of undergoing acupuncture for CRP. Methods: A pragmatic randomised controlled trial will be conducted in South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Adults with cancer related pain (n = 106) will be randomised in a 1:1 ratio to receive the acupuncture intervention up front versus after a wait list period of 4 weeks. Pain level (by Numerical Rating Scale), analgesic use, auricular acupressure frequency and adverse events will be assessed at baseline, mid-treatment and post-treatment. Expectancy on trial outcome (by Credibility and Expectancy questionnaire) will be assessed at baseline. The perspective of the participants (by an interview) will be recorded after the last intervention. Expected outcomes: We hypothesise that acupuncture will relieve cancer related pain at mid-treatment and post-treatment. We also hypothesise that few adverse events will be provoked by acupuncture. Trial registration: Australia New-Zealand Clinical Trial Registry (ACTRN12620000325909).

scholarly journals A PROSPECTIVE SURVEY OF APPROPRIATENESS OF PAIN PHARMACOTHERAPY MANAGEMENT IN POST-CESAREAN SECTION PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL

2019 ◽  
pp. 280-283 ◽  
Author(s):  
JOHAN ◽  
INSTIATY ◽  
NAFRIALDI ◽  
YUDITIYA PURWOSUNU
Keyword(s):  
Pain Management ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Management Index ◽  
Post Surgery ◽  
Emergency Cesarean ◽  
Experienced Pain ◽  
Chi Squared ◽  
Numerical Rating ◽  
Numerical Rating Scale Score

Objective: In this study, we sought to assess the pattern of analgesic usage, adequacy of pain management, side effects, and analgesic drug interactionsin the post-emergency cesarean surgery setting.Methods: This was a prospective observational study of 80 patients who underwent emergency cesarean surgery at the Obstetrics and GynecologyDepartment of the Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN-CM) between July 2015 and January 2016. Adequacy of painmanagement during the first 3 post-operative days was assessed using Pain Management Index. Relation between pain intensity during activities andrest with patient characteristic was assessed using Chi-squared test and Fischer’s exact test.Results: Nineteen patients (8.7%) were prescribed two types of nonsteroid anti-inflammatory drugs concomitantly, and 41.8% received inappropriateanalgesics at a lower frequency. Most patients experienced pain with numerical rating scale score >3 in the first 24 h post-surgery: 59 patients(73.75%) experienced pain during activities and 7 patients (8.75%) during rest.Conclusion: Post-emergency cesarean surgery pain management at RSUPN-CM was not optimal. Most patients did not receive adequate painmanagement in the first 24 h post-surgery.

scholarly journals Comparative Effectiveness of Pediatric Integrative Medicine: A Pragmatic Cluster-Controlled Trial

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 311
Author(s):  
Sunita Vohra ◽  
Salima Punja ◽  
Hsing Jou ◽  
Michael Schlegelmilch ◽  
Beverly Wilson ◽  
...  
Keyword(s):  
Usual Care ◽  
Integrative Medicine ◽  
Symptom Severity ◽  
Complementary Therapies ◽  
Rating Scale ◽  
Conventional Medicine ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Future Research ◽  
Numerical Rating

Symptoms of pain, nausea/vomiting, and anxiety (PNVA) are highly prevalent in pediatric inpatients. Poorly managed symptoms can lead to decreased compliance with care, and prolonged recovery times. Pharmacotherapy used to manage PNVA symptoms is of variable effectiveness and carries safety risks. Complementary therapies to manage these symptoms are gaining popularity due to their perceived benefits and low risk of harm. Pediatric integrative medicine (PIM) is the combination of complementary therapies with conventional medicine in pediatric populations. A two-arm, cluster-controlled, pragmatic clinical trial was carried out to compare the effectiveness of a PIM service in conjunction with usual care, versus usual care only to treat PNVA symptoms in hospitalized pediatric patients. The primary outcome was the improvement of PNVA symptom severity using a 10-point numerical rating scale. Participant enrollment occurred between January 2013 and January 2016. A total of 872 participants (usual care n = 497; PIM n = 375) were enrolled. The PIM therapies significantly reduced PNVA symptom severity (p < 0.001). This study found that a hospital-based PIM service is both safe and effective for alleviating PNVA symptoms. Future research should carry out this work in other pediatric inpatient divisions, and in other sites to determine the reproducibility of findings.

scholarly journals GAMBARAN SKALA NYERI PADA PASIEN PASCABEDAH CAESAR DENGAN PENGGUNAAN OBAT KETAMIN DOSIS RENDAH

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Richi M. Posumah ◽  
Harold F. Tambajong ◽  
Lucky T. Kumaat
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Caesarean Section ◽  
Low Dose ◽  
Rating Scale ◽  
Anaesthetic Agent ◽  
Numerical Rating Scale ◽  
Emotional Experience ◽  
Pain Scale ◽  
Numerical Rating

Abstract : Pain is an uncomfortable sensorical feeling and emotional experience that relate to the destruction of tissue actually or potentially. Pain management is an important thing for the postoperative patients. Postoperative pain causing the change of body hormones that eventually lead to pain, nausea and vomitting. Postoperative pain management is an important aspect and therefore the analgetic drugs will be administered to overcome the pain. Not only function as an anaesthetic agent, low dose ketamine also has an analgetic effect. This study was aimed to determine the pain scale of the caesarean section patients using low – dose ketamine. This is an descriptive prospective study and the samples were the postoperative caesarean section patients from Prof. DR. R.D Kandou Hospital, Bhayangkara Hospital and GMIM Pancaran Kasih Hospital in Manado from December 2015 – January 2016. Patient that has been finished the operation were administered low dose ketamine as bolus 0,1 mg/kg and continuous IV 0,1 mg/kg/hour for 6 hours then the pain were assessed by using the Numerical Rating Scale (NRS) and FACES Pain Scale (FPS) starts from two hours, four hours and six hours after the ketamine was administered. Conclusion : Low dose ketamine was able to lower postoperative pain on caesarean section patients.Keywords : Postoperative Pain, Pain Scale, Caesarean Section, Low – Dose KetamineAbstrak : Nyeri merupakan perasaan sensorik dan pengalaman emosional yang tidak nyaman dan berhubungan dengan kerusakan jaringan secara actual maupun potensial. Manajemen nyeri merupakan hal yang penting dalam penganganan pasien pascabedah. Nyeri yang disebabkan oleh pembedahan terjadi karena perubahan hormon – hormon dalam tubuh dan hasilnya berupa rasa nyeri, mual dan muntah. Manajemen nyeri pascabedah merupakan aspek penting maka diberikan obat analgetik untuk mengatasinya. Selain sebagai obat anestetik, obat ketamin dengan dosis rendah memiliki fungsi analgetik. Tujuan penelitian ini adalah untuk mengetahui gambaran skala nyeri pada pasien pascabedah caesar dengan menggunakan obat ketamin dosis rendah. Penelitian ini bersifat deskriptif prospektif dan sampel merupakan pasien pascabedah caesar diambil di RSUP. Prof. DR. R. D. Kandou Manado, RS Bhayangkara Mando dan RSU GMIM Pancaran Kasih Manado yang dilaksanakan pada bulan Desember 2015 – Januari 2016. Pasien setelah selesai operasi diberikan ketamin dosis rendah dengan dosis bolus 0,1 mg/kg dan infus kontinyu IV 0,1 mg/kg/jam selama 6 jam kemudian penilaian nyeri pasien menggunakan skala nyeri Numerical Rating Scale (NRS) dan FACES Pain Scale (FPS) pada jam II, jam IV dan jam VI setelah pemberian obat ketamin. Simpulan : Ketamin dengan dosis rendah mampu menurunkan nyeri pascabedah pada pasien bedah caesar.Kata Kunci : Nyeri Pascabedah, Skala Nyeri, Bedah Caesar, Ketamin Dosis Rendah

scholarly journals Effectiveness of acupressure on pain management among mediosternotomy patients

2019 ◽  
Vol 10 (3) ◽  
pp. 2507-2514
Author(s):  
Pritha L ◽  
Valliammal S ◽  
Vijayaraghavan R
Keyword(s):  
Pain Management ◽  
Heart Surgery ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Wrist Joint ◽  
Demographic Data ◽  
Alternative Therapy ◽  
Open Heart Surgery ◽  
Median Sternotomy ◽  
Numerical Rating

Acupressure is an alternative therapy that uses fingers and hands to stimulate acupoints and maintains the balance of energy. It was well documented that acupressure is effective in relieving different types of pains in patients with different conditions. The present study was undertaken to evaluate the effect of acupressure in pain and improving the bio-physiological parameters among mediosternotomy patients. The present study was conducted at Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore. A total of twenty male and female patients those who undergo open-heart surgery via median sternotomy were part of the study after obtaining the written informed consent. After recording the demographic data, the participants were randomly grouped into control and intervention groups using random numbers generated by computer with 10 participants in each group. The intervention will be provided at PC6 acupressure point, situated on the inner side of the forearm, three fingers below the wrist joint, three times a day for four days.  Numerical Rating Scale of pain was used to assess the pain of the Participants. There was a significant decrease in the pain score of the participants, followed by the acupressure. The study provides further evidence for the effectiveness of the acupressure in pain management and also recommends detailed research in this area.

scholarly journals P091: Evaluation of pain management in medical transfer of trauma patients by air

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S109
Author(s):  
I. Miles ◽  
R. MacDonald ◽  
S. Moore ◽  
J. Ducharme ◽  
C. Vaillancourt
Keyword(s):  
Pain Management ◽  
Management Practices ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Primary Objective ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Transport Services ◽  
Standard Deviation Range ◽  
Medical Transport

Introduction: Medical transport services are essential in the regionalization of trauma care. Given the limited number of designated trauma centers, transport times can be prolonged, with patient care managed by paramedics for the duration of their transfer. Pain management is a paramount component, but oligoanalgesia can occur. The primary objective of this study was to evaluate pain management practices during transport of trauma patients by air. Methods: We conducted a 12-month review of ORNGE electronic paramedic records. ORNGE is the exclusive provider of air and land transport in Ontario, Canada. Cases from 1 January 2015 to 31 December 2015 were screened. Patients were identified according to inclusion (≥18 years old requiring transportation to designated trauma center) and exclusion criteria (GCS&lt;14; intubation; accompanied by a nurse or physician). Information was collected in a standardized, piloted data form used by a single trained data extractor. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment according to changes on a 10-point numeric rating scale (NRS), patterns of analgesia administration, and analgesia-related adverse events (AEs). Results were reported as mean, (standard deviation), [range], or percentage. Results: Of 600 potential records, 372 patients met our inclusion criteria with the following characteristics: age 47.0 [19-92] years; 70.4% male; 97.0% blunt injury. Duration of transport was 82.4 (46.3) minutes. Pain was initially assessed in 90.0% of patients. Overall, NRS at baseline was 4.9 (2.8). Of the 62.4% who received analgesia, NRS at baseline was 5.9 (2.5). Fentanyl was most commonly administered (78.5%) at 44.3 [25-60] mcg. NRS after the first dose of analgesia decreased by 1.1 (1.6) points. A total of 73.7% of patients received further analgesia, equal to 2.4 [1-19] additional doses. While 23.4% of patients had no change in NRS after the first dose of analgesia, subsequent doses resulted in no change in NRS in over 65% [65.4-71.3] of patients. A total of 43 AEs (6.7%) were recorded after 638 doses of analgesia, and the most common AE was nausea (39.5%). Conclusion: The majority of patients were assessed for pain. Although the first analgesia administration had minimal effect on NRS, subsequent doses appeared to have even less of an impact. AEs were infrequent.

Sign in / Sign up

Export Citation Format

Share Document