Question about analgesia in emergency patients

[Valerie13]

Hi guys.

I was wondering if you guys can help me out with a question I have.
Hi guys. I asked this question in the anesthesiology forum but was told I could probably get better answers here.

Here it is:
If you have an emergency patient that has injuries due to trauma (let's say the person was hit by a car), and the person is in pain, are there any contraindications to giving the patient analgesia if you do not really know the severity of the other injuries (could the body handle to drug)? For example, the patient could be in shock, in respiratory depression, and dehydrated....and could have internal bleeding (and possible organ damage).

I'm just trying to figure out what the standard protocols are for giving analgesics in emergency patients....

Thanks!!!

Val
(this question is just for curiosity...)

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[roja]

This is a complicated question, as there are so many variables to an 'emergent patient'.

In general, pain should be adressed. You should know that many narcotics can cause hypotension.

You have to take this question case by case... And first adress your ABC's.

Once you have stabilized a patient, you should give analgesia. Its cruel not to.


And in general, the motto of surgeons not wanting analgesia for primary exams, we don't tend to have this problem here. Initially surgical residents would spout that, and it was dealt with in two ways: 1- 'we are going to give this patient some morphine. if you want to examine them without the analgesia on board, then you need to be down here in the next 5-10 minutes.
2- when they arrived and examined the patient, they were quoted (and often handed) several studies which have shown that you actually get a better abdominal exam WITH analgesia on board.


Just don't give a patient that is 1-bleeding copious amounts of blood or 2- might be going to the OR toradol or motrin. You won't make friends of your surgical friends

 

[Apollyon]

Its cruel not to.

And malpractice, too. Physicians across the board have been sued and lost for inadequate/absent analgesia. The worst is patients chemically paralyzed and not sedated or given analgesia.

 

[Gunner04]

There was a recent study published in one of the EM journals about the effects of morphine on the diagnosis of acute appy's. There was no difference in detecting them in the group with pain control. Not a trauma situation, but it still demonstrates the point.

 

[rdennisjr]

Fentanyl is a nice short-acting med also - if it is something that will need some observing or a delay before the OR / surgery eval, you can control pretty high levels of pain and yet have a short half-life if your surgery staff insist on no pain control before there exam.

Dennis

 

[NinerNiner999]

Morphine (and other opiates) are also commonly used and preferred due to their easy reversal with Narcan.

 

[DrQuinn]

I prefer Fentanyl in my trauma patients... wears off pretty quickly if they become too hypotensive.

In my non emergent patients, I'll use either Morphine or Fentanyl. If its someone with some major pain issues I'll use Dilaudid.

Q

 

[Sessamoid]

Study notwithstanding, I did have one case where the exam was initially very suspicious for appendicitis. After my usual judicious amount of morphine, his abdominal exam was almost completely benign, and remained so for several hours. The appy was confirmed on CT (and in the OR). Weird. Not everything fits into studies and textbooks.