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MANAGEMENT IN
EMERGENCY DEPARTMENT
Dedi Susila, dr., SpAn., KMN., FIPM
Pain and Regional Anasthesia division,
Department of Anastesiology & Reanimasi FK UNAIR-RSUD Dr Soetomo
Introduc)on
Research shows that pain is the primary issue
for more than 70 % of paAents who present at
emergency department ( ED )
60 % to 80 % paAents have acute pain
More than 47 % of the paAents seen in the ED
complain of procedural pains
Most paAents experience pain from
nontraumaAc causes
Michel Galinski, Acute Pain Management in Emergency Medicine
Correspondance: m.galinski@trs.aphp.fr, Site CNRD: www.cnrd.fr
Categories of illnesses presen)ng
with pain in ED
Trauma (fractures, dislocaAons, strains)
Wounds
Back and neck pain
Abdominal pain
Headache
Chest pain (noncardiac)
Abscesses, celuliAs
Toothache
Urinary tract infecAon
Upper respiratory tract infecAon
Renal colic
Todd KH et al. Pain in the emergency department: results of the pain and emergency medicine
iniMaMve (PEMI) mulMcenter study. The Journal of Pain 2007; 6:460-466
Barriers to Pain Management
A recent study shows that pain treatment is
also inadequate in ED world wide
It has recognised the term of oligoanalgesia
Barriers to pain management into :
- Healthcare system related
- Healthcare provider related
- PaAent related
MarMn Duignan, Barriers to Pain Management in Emergency Departments, Emergency
nurse vol 15 no 9 February 2008
ObjecAve of the Pain Management In ED
Phospholipase
Arachidonic Acid
COX-1 COX-2
Prostaglandins Prostaglandins
Gastric ProtecAon Acute Pain
Kidney protecAon InammaAon
Platelet Hemostasis Fever
THE BEGINNING OF INFLAMMATION PAIN
Nociceptor
Eec)ve management of acute pain
in the ED requires :
1 Assessment of the pain
2 Provision of appropriate analgesia in an
appropriate Ame frame via an appropriate
route
3 Reassessment of pain to determine the eect
of treatment and assess for adverse eects
DX : - severe pain
- Acute pain, non cancer cause
- NocicepAve mechanism
- Other factors may be contribuAng ( fear,
anxienty )
Case example 2:
55 year old woman with metastaAc breast
cancer. Large tumour of lem breast with spread
to spine causing severe pain.
DX : - Severe pain
- Chronic cancer pain and acute musculoskeletal
pain caused by spinal metastases
- Both nocicepAve and neuropathic mechanism
- MulAple factors maybe contribuAng
Target Point of Analgesic Agents
Ketamin
Paracetamol
Gabapen)n
Percep)on
Opioids
Gabapen)noids
Clonidine
Dexamethasone
Ketorolac
Cor)costeroids
NSAID
Modula)on Transduc)on COXIB
Local Anesthe)c
Transduc)on
DRG
Transmission
Modula)on
Local anesthe)cs
Cryotherapy
COXIBs
Assessment of acute pain in the ED