Pain management in the ED Flashcards
When to avoid acetaminophen
severe liver disease
When to avoid ibuprofen & ketorolac
- renal dysfunction
- heartburn, GERD, GI bleed
- anemia
- anticipated surgery
- head injury (unless CT neg)
- CV disease
when to avoid fentanyl
- no dose adjustments for renal or liver impairment
- elderly need about 1/2 the normal dosing; decreased doses in pediatrics; useful if pain control needed before procedural sedation
avoid in children, not great for pain control
Codeine
doesn’t work well for pain, lowers seizure threshold; basically should not be used
tramadol
potent
hydrocodone
more potent
oxycodone
Even more potent
Hydromorphone
seems to have have fewer euphoric effects and perhaps less abuse potential than hydrocodone or oxycodone
Morphine IR
agent of choice for a digital nerve block
lidocaine 1%
bupicicaine
indication: finger trauma, toe trauma, toenail removal
agent of choice for hematoma block
lidocaine
bupivicane
indication: fracture requiring reduction
agent of choice for dental block
Bupivivaine 0.5% w epi
indications: dentalgia, facial laceration
agent of choice for auricular block
lidocaine w/or without epi
indications: auricular laceteration or hematoma
NPO based off of substance ingested?
- clear liquids: 2 hrs
- breast milk: 4 hrs
- infant formula: 6 hrs
- non-human milk: 6 hrs
- light meal: 6 hrs
- longer procedures
- laceration repair
- I & D
- smaller doses now used for pain managment
- used for combative patients
eyes are open but no one is there
ketamine
