Pain Management

Question 1

Typical (non-pharmaceutical) measures to control pain should include: (list 6)

Answer 1

• Reassurance
• Gentle handling
• Control of temperature (avoid shivering) by using blankets or warming the ambulance
• Positioning of the patient or limbs; ensuring adequate support and padding
• Splinting of the limb to avoid motion
• Application of cool dressing to small burns (while avoiding cooling of the patient)

Question 2

Entonox can cause rebound hypoxemia due to displacement of oxygen in the alveoli as the nitrous diffuses out of the blood stream. Therefore, all patients receiving entonox should receive follow-up treatment with:

Answer 2

High flow oxygen

Question 3

The onset of entonox is _____ (rapid / slow), and the elimination of entonox is _____ (rapid / slow).

Answer 3

Rapid, rapid

At a constant inspired concentration the rise time of alveolar concentrations is faster than that of any other anaesthetic agent. The elimination of nitrous oxide equally is faster than that of any other anaesthetic. This characteristic is especially valuable in analgesia for short-term pain relief.

Question 4

Indications for entonox administration are: (list 3)

Answer 4

• Relief of moderate to severe pain.
• Cardiac related chest pain where nitroglycerin will be of no value or is contraindicated. Must be followed by high flow oxygen when discontinued.
• Isolated extremity injuries, pain associated with burns excluding mechanisms associated with potential inhalation injury, etc.

Question 5

Contraindications to entonox administration are:

Answer 5

C - Inability to comply

D - Decompression sickness

C - Altered level of consciousness

P – Pneumothorax

A - Air Emboli

I - Inhalation inury

N - Nitroglycerin use within 5 mins

Entonox should also be used only in the context of adequate ventilation and never within aircraft

Question 6

Cautions for entonox administration are:

Answer 6

S - Shock

A - Abdominal distention

D - Depressant drugs

C - COPD

F – Facial injuries

Question 7

Entonox cylinders should be maintained at a temperature of ___ to ensure adequate mixing of gases

Answer 7

>10^oC

Question 8

To ensure adequate mixing of gases, entonox cylinders should be __________ prior to administration.

Answer 8

inverted 3 times

Entonox cylinders maintained at an appropriate temperature - >10^oC - will have adequate mixing of gases already, but there is no risk in inverting the tank to be sure.

Question 9

To reduce the chance of spreading pathogens between patients and crews, entonox should always be administered using __________

Answer 9

a bacterial/viral filter between the patient and the Entonox demand valve regulator.

Question 10

Entonox ___ (is / is not) safe for use with pregnant and perinatal patients.

Answer 10

Is

Entonox is an effective analgesic, especially when combined with reassurance and positive enforcement. It is the analgesic of choice in many countries for childbirth.

Question 11

Entonox ____ (is / is not) effective for pain management in cardiac-related chest pain

Answer 11

Is

Entonox is indicated for cardiac related chest pain where nitroglycerin will be of no value or is contraindicated. Must be followed by high flow oxygen when discontinued. May not be given within 5 minutes of previous nitroglycerin administration.