Pain

Question 1

what does pain do to the myocardium?

Answer 1

increases demand for oxygen with hypertension and tachycardia

Question 2

what does pain risk?

Answer 2

inability to cough > chest infections
inability to move > DVTs, pressure sores
chronic pain

Question 3

four point pain score used on NEWS charts

Answer 3

0 = no pain at rest or movement
1 = no pain at rest, slight on movement
2 = intermittent rest pain and moderate on movement
3 = continuous rest pain, severe on movement

Question 4

what precedes opioid induced respiratory depression?

Answer 4

sedation

Question 5

charting sedation

Answer 5

0 = none, patient alert
1 = mild, occasionally drowsy but easy to rouse
2 = moderate, frequently drowsy, easy to rouse
3 = severe, somnolent, difficult to rouse
S= sleep

Question 6

management of respiratory depression

Answer 6

RR <10 give O2 6L/min
consult pain team
naloxone titrated up

Question 7

what can epidural and spinal anaesthetics cause late?

Answer 7

respiratory depression

Question 8

management of opioid-induced pruritis

Answer 8

naloxone

chlorpheniramine

Question 9

what INR is needed in spinal and epidural anaesthetic?

Answer 9

<1.5

Question 10

what is PCA

Answer 10

IV infusion where patient presses a button to get a bolus dose. it has a lock-out after 5 minutes

Question 11

what to avoid giving when on PCA?

Answer 11

oral opioids

Question 12

when to stop PCA?

Answer 12

when patient can tolerate analgesia orally

Question 13

duration of chronic pain?

Answer 13

> 3 months

Question 14

long-term side effect of analgesia?

Answer 14

medication overuse headache

Question 15

rescue dosing

Answer 15

1/6th of background 24-hour dose

if you increase maintenance, remember to increase background