04 - Dying patient / 16 - coma Flashcards
How do you certify death
General inspection Response to verbal and painful stimuli Respiratory inspection for 3 mins Pupillary reflexes Feel for a central pulse. Auscultate heart sounds for 1 min
Document and inform nursing staff.
Criteria for brain death
Absent respiratory effort Absent pupillary reflexes Absent cough, corneal, gag and oculocephalic reflexes Absent oculovestibular reflex Absent spontaneous movement
3 types of pain
Pain is nocioceptive if it is triggering sensory nerve fibres.
Pain is neuropathic if it is caused by damage to the somatosensory nervous system itself.
Psychogenic pain is that originates from within the brain and has a large psychological and behavioural component
2 types of nerve fibres that carry pain
A delta - sharp
C fibres - dull pain
Which tract carries pain? to where?
They ascend via spinothalamic tract to thalamus and brain stem. Some of these extend to the somatosensory and anterior cingulate cortices.
Strong pain killers used ?
For palliative care?
capsaicin, amitriptyline, gabapentin, pregabalin, duloxetine, clonazepam, ketamine, naproxen,
In palliative: methadone, dexamethasone
Eg of an agent used for nerve blocks?
how does it work?
Lidocaine
Block sodium channel in cell membranes and prevent the transmission of an action potential.
Thus pain signals are not even created.
Usually contain adrenaline.
How do NSAIDs control pain?
Inhibit COX as part of inflammatory pathway.
How do opiates control pain?
with Mu-Kappa-Delta receptors in the brain and pain neurons synapsing with spinal cord.
Analgesia mostly from delta activation in the brain
2 main strengths of opiates?
: Codeine, tramadol
: Morphine, oxycodone, fentanyl, buprenorphine, pethidine
How to anti-emetics work?
chemoreceptor trigger zone in medulla
Eg of some anti-emetics ?
Favoured for post op nausea?
Ondansetron metoclopramide cyclizine domperidone levomepromazine
Buscopan (hyoscine) for colicky pain and post-op nausea
Haloperidol (only in palliative)
