Acute pain case
Assess:
Pain
Each site of pain graded
Mechanism of pain
Temporal factors
Etiology
Function
Ambulate
ADLs
ROM
Breathing/Coughing
Psychosocial issues
Patient distress
Supports
Psychiatric history
Patient/family knowledge and understanding
Barriers - cultural/language
Acute Lignocaine overdose
Acute ketamine overdose
Opioid overdose
Acute emergency scenario
Ensure no danger such as sharps
Call for help
Check for response and breathing
If suspect opioid intoxication such as miosis though normal pupils does not exclude intoxication, IM Naloxone 400 mg bolus (2 mg if cardiac arrest)
Ask team to prepare for infusion
A - Check airway patent and secure with guedel if required, head tilt and chin thrust,
B - Provide 100% oxygen 15 L via NRB mask and/or bag/mask ventilation, respiratory rate and saturations
C - Ensure monitoring including HR, BP, and IV access 2 large bore 16 G cannulas, ECG monitoring - 500mL boluses of NSaline +/- inotropes +/- atropine/pacing
D - Temperature
E - Check for other signs of injury and secondary survey
DEFG - Check for BSL
Draw bloods including drug screen, serum paracetamol level, ELFTs
Naloxone half life of 30 minutes
Target of naloxone is adequate ventilation NOT arousal
IV route is best though IM is fine
Can cause significant agitation on waking
Manage pain with PCA if required following arousal and naloxone has worn off
Needs significant monitoring
Differentials for unconsciousness:
Alcohol/Acidosis
Environmental (hypothermia), Electrolytes, Endocrine
Infection
Overdose / Oxygen deficiency
Uraemia
Trauma/Tumour (e.g. brain)
Insulin (diabetes)
Psychogenic / Poisons
Stroke / Shock
Respiratory depression/suppression case
Naloxone
Epidural complications
Why not long acting?
N&V Treatments
Ondansetron
Droperidol
Dexamethasone
Cyclizine
Substance use disorder case
DSM5 Criteria (three levels of severity)
Impaired control
Social problems
Risky use
Physical dependence
***** use disorder (e.g. Alcohol, cannabis)
Intoxication
Withdrawal
Acute pain in substance use disorder / OST
Confirm dose and route with pharmacist/prescriber
Assess other prescribed medications
Medical comorbidities
Psychiatric comorbidities
Social factors
Opioid case
OIVI
Opioid naive
Incomplete cross-tolerance
Breakthrough pain
OIH
Tolerance
Dependence
Substance use disorder
5A's
COMM/ORT
Procedures
Headache/Facial pain
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