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Advanced forms of pain relief
Fichas del conjunto (26)
- 1pain definitionunpleasant sensory and emotional experience associated with actual or potential tissue damage, described in terms of such damage
- 2type of painacute, chronic, nociceptive, neuropathic
- 3acute painrecent onset, limited duraton
identifiable cause, indicayes injury and illness, predicatable course - 4chronic or persistent painpersistent, cause is often obscure, sensitisation of noiceptors or nerves, poorly responsive to therapy, including opioids, unpredictable
- 5Nociceptive painmost common in acute settings
stimulation of nociceptors as result of tissue damge
pain characteristics - somatic = sharp, ot, stinging
visceral = dull, crampy - 6neuropathic paindysfunction in nervous systen - nerve pain
e.g. amputation of limb, burning, pulsing, shooting, tingling, hyperalgesia (increased pain with painful stimuli) , allodynia (pain with non-painful stimuli) - 7prolonged injury responsehyperglycaemia - increased risk of infection, length of stay
increase in fatty acids - myocardial o2 consumption
increase in coagulation - increase DVT/PE
increase muscle protein breakdown - decrease wound healing
decrease immune function - increase infection - 8prolonged sympathetic reponseincrease heart rate, BP, myocardial oxygen, ischaemia, decreased GI motility - ileus
- 9major complications of bed restIncrease pulmonary complications, decrease lung volumes, hypoxaemia, increase thromboembolism
goal: mobilise and cough comfortably - 10Measuring painsubjective - only patient knows
- 11assessing pain atrest and movement - reassess after analgesic administration
- 12FASassessment of function, the ability to deep breathe/cough, participate in physio
a - no limitation due to pain
b - mild limitation
c - unable to complete activity - 13non-pharmacological managementrest, position, elevation, compression, reaasurance, explanation, expectation
- 14Pharmacological managementopioids- IV, PCA, oral, SC
non- opioids - paracetamol, NSAIDS, ketamine, anticonvulsant, antidepressants
neuraxial - epidural, intrathecal regional - 15morphineleast lipid soluble - slower onset of action, longer duration
active metabolites - M3G M6G
renal excretion - caution with elderly
SR - kapanol, MS contin - 16Fentanylhighly lipid soluble - fast onset, shorter action
no active metabolites - safer for renal impairment and elderly
SR - transdermal - durogesic patch - 17Oxycodonefirst line opioid
semi - synthetic opioid derivative of thebaine not codiene
no harmful metabolites - suitable for elderly
SR - oxycontin, targin - 18Tramadolsynthetic - opioid like analgesic
combined effect
SSRI
reduces pain transmission and perception
active metabolite - caution elderly
lower risk of sedation and resp depression
lower risk of constipation - 19Adverse effect of opioidsnausea and vomiting -- antiemetics
Pruritis - naloxone, antihistamines
urinary retention
constipation
sedation and resp depression - 20opioid effect on resp systemdecreased rate, rhythem irregular, decrease tidal volume, increase co2, sedation, depression of upper airway tone and obstruction
resp rate is a late and unreliable sign
increasing sedation is a better sign - 21sedation scoreso- wide awake
1- easy to rouse, remains awake
2- easy to rouse but cannot stay awake
3 - difficult to rouse (severe resp depression) - 22Naloxoneopioid antagonist
half life 30-60 minutes - 23Adjunvantsparacetamol, NSAIDS, ketamine, anticonvulsants, antidepressant are all opioid sparring lead to reductoin of opioid required, fewer side effects
- 24Ketamineblocks NMDA receptors in the spinal cord
side effects : vivid dreams, hallucinations - 25dermatomearea of skin that is mainly supplied by a single nerve which originates in the epidural space
- 26epidural complicationssystemic toxicity
tingling, umbenss, metallic taste, light headed, coma, convulsions
treatment: stop infusoin, resp and cario support
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- El usuario ha eliminado su información de asignaturas Fichas sobre Advanced forms of pain relief, creado por Usuario eliminado el 13/06/2018.
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- Creado por Elizabeth Then · 13 jun 2018
- Copiado por Elizabeth Then · 13 jun 2018
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