Acute Traumatic Pain in the Emergency Department
Abstract
:1. Background
2. Material and Methods
3. Discussion
3.1. Evaluation of Signs and Symptoms
3.2. Pain Managment
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- Patient refusal.
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- Infection at the injection site. The insertion of a needle through infected into healthy tissue may spread infection. In addition, local anesthetics do not work well in acidotic tissue.
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- An allergy to local anesthetics.
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- The inability to guarantee sterile equipment to perform the block. This is an absolute contraindication as this could result in the introduction of infectious agents into otherwise healthy tissue.
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- Great risk of local anesthetic toxicity (i.e., one would not want to perform or repeat a bilateral axillary block).
3.2.1. Administration Routes for Trauma Patients in the Emergency Department
3.2.2. Pharmacological Approach
3.2.3. Invasive Pain Management in the Emergency Room
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- Dislocation of the shoulder.
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- Fracture of the clavicle.
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- Proximal humerus fracture.
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- Low-energy distal radius fracture.
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- Hand and finger injuries.
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- Fracture and dislocation of the hip.
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- Low-energy fractures of the foot and ankle.
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Age | Scale | Rating | Interpretation |
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age 0–4 years old | FLACC Faces, Arms, Legs, Cry, Consolability | 0–2 points for each domain. Maximum score will be between 0–10. |
|
CHEOPS Children’s Hospital of Eastern Ontario Pain Scale (cry, facial, verbal, torso, touch, legs) | 0–3 points for each domain. |
| |
age 4–10 years old | FPS Faces Pain Scale | The scale uses the association of stylized facial expressions. | scores from 5 to 1 on a decreasing pain scale |
Faces Pain Scale—Revised the age range 4–16 years | Score the chosen face 0, 2, 4, 6, 8, or 10, counting left to right. | “0” equals “No pain” and “10” equals “Very much pain” | |
Wong–Baker FACES®® Six faces, corresponding to six different degrees of pain | Each face also has a number from 0 to 10, which coincides with the intensity of pain. | “0” equals “No pain” and “10” equals “Very much pain” | |
age >10 years old/adult | VRS Verbal Rating Scale | The patient verbally rates the pain. |
|
VAS Visual Analogue Scale | A 10 cm long straight line whose extremes represent the conditions of no pain and maximum possible pain. | ||
NRS Numerical Rating Scale | Scale of pain intensity from 0 (no pain) to 10 (the most terrible pain imaginable). |
Title | Period | Population | Conclusion |
---|---|---|---|
Cordell, WH et al. The high prevalence of pain in emergency medical care. The American Journal of Emergency Medicine [1]. | 2022 | ED patients (aching, burning, and discomfort). | Pain was a chief complaint for 52.2% of the visits. |
Todd, KH et al. A Review of Current and Emerging Approaches to Pain Management in the Emergency Department [2]. | Systematic review—2000–2018 | A new generation of emergency physicians is seeking additional training in pain medicine to obtain a better management of pain in the emergency department. | |
Court-Brown, CM et al. The epidemiology of acute sports-related fractures in adults [3]. | Retrospective analysis—2000 | Database containing all in-patient and out-patient fractures in a defined patient population in 2000. | Sporting activities are the third most common cause of fractures and traumatic pain. |
Raffa, RB et al. Pharmacology of oral combination analgesics: Rational therapy for pain [13]. | Many combination analgesics are available and are commonly prescribed for pain. The goal is to facilitate patient compliance, simplify prescribing and improve efficacy without increasing adverse effects. | ||
Xia, AD et al. Evaluation of pain relief treatment and timelines in emergency care in six European countries and Australia [18]. | Observational, retrospective chart review—2013–2017 | Treatment outcomes in medical emergency situations in Sweden and Australia. | While effective pain management is an important part of emergency care, oligoanalgesia is frequently reported and can have a substantial impact on patients’ physical and emotional wellbeing. |
Lyrtzis, C et al. Efficacy of paracetamol versus diclofenac for Grade II ankle sprains [21]. | Controlled randomized study—2011 | Ninety patients, 18 to 60 years old, with Grade II acute ankle traumatic sprains. | Diclofenac and paracetamol had the same effect on pain reduction. |
Craig, M et al. Randomized comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department [10]. | Randomized, double-blind pilot study—2012 | Patients between 16 and 65 years old with isolated limb trauma and in moderate to severe pain. | Intravenous paracetamol appears to provide a level of analgesia comparable to intravenous morphine. |
Abdollahpour, A et al. A review on the recent application of ketamine in management of anesthesia, pain, and health care [32]. | Systematic review—2020 | Ketamine is a drug of choice for the cases where opioid tolerance, inflammatory pain, neuropathic pain component, and depression or a combination of these factors are problematic. | |
Diwan, S et al. A retrospective study comparing analgesic efficacy of ultrasound-guided serratus anterior plane block versus intravenous fentanyl infusion in patients with multiple rib fractures [39]. | Retrospective cohort study—2021 | 72 patients in ED for multiple rib fractures. | US-guided SAPB is an opioid-sparing, effective interfacial plane block which is safe and should be considered early in all patients. |
Gadsden, J et al. Regional anesthesia for the trauma patient: improving patient outcomes [40]. | Systematic review—2015 | RA in the ED is a valuable, opioid-sparing tool in multimodal pain control with a positive impact on patient LOS and some traumatic injury outcomes. |
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Zanza, C.; Romenskaya, T.; Zuliani, M.; Piccolella, F.; Bottinelli, M.; Caputo, G.; Rocca, E.; Maconi, A.; Savioli, G.; Longhitano, Y. Acute Traumatic Pain in the Emergency Department. Diseases 2023, 11, 45. https://doi.org/10.3390/diseases11010045
Zanza C, Romenskaya T, Zuliani M, Piccolella F, Bottinelli M, Caputo G, Rocca E, Maconi A, Savioli G, Longhitano Y. Acute Traumatic Pain in the Emergency Department. Diseases. 2023; 11(1):45. https://doi.org/10.3390/diseases11010045
Chicago/Turabian StyleZanza, Christian, Tatsiana Romenskaya, Marta Zuliani, Fabio Piccolella, Maria Bottinelli, Giorgia Caputo, Eduardo Rocca, Antonio Maconi, Gabriele Savioli, and Yaroslava Longhitano. 2023. "Acute Traumatic Pain in the Emergency Department" Diseases 11, no. 1: 45. https://doi.org/10.3390/diseases11010045