pain medicine Flashcards
acute vs subacute vs chronic pain
acute: less than 1 month
subacute: 1 month to 3 months
chronic: > 3-6 months
how long to prescribe opioids for acute pain
3-7 days
somatosensation
sensory neurons activated by physical stimulus (perception of touch, pressure, pain)
Nociception
first step in pain signal due to tissue damage or potential tissue damaging stimuli - neurologic receptor capable of differentiating noxious + innocuous stimuli
A-beta afferent fibers
fastest, thick myelination, light touch, pressure, hair movement, not usually pain
A-delta afferent fibers
thinly myelinated, sharp and intense pain sensation, high and low threshold mechanical and thermal receptors
C afferent fibers
slowest, unmyelinated, free nerve endings, high threshold to thermal, mechanical, or chemical insults, prolonged burning that follows initial A-delta stimulus
Nociceptive pain
noxious stimulus of somatic or visceral structures
mediated by receptors in viscera, bone, dermis, muscle, and CT
exacerbated by position change
Neuropathic pain
damaged for dysfunctional nerve tissue or damage to CNS
from tissue injury or pathology induced injury
Nociceptive pain ____ receptive to opioids
Neuropathic pain ____ receptive to opioids
IS
IS NOT
Pain diagnostics
Wong-Baker FACE scale, McGill pain questionnaire, Brief pain impact questionnaire, rate 1-10
Opioid management for chronic pain
immediate release first
prescribe lowest effective dose
reevaluate in 1-4 weeks
urine drug testing
NO benzos or other opioids
What symptoms might a patient experience when using LSD?
The patient may want to hurt himself, state they have been ‘freaking out,’ and experience hallucinations.
what are inhalant-related disorders
inhalation of certain gasses found in pain, petroleum, toluene, glues, and nail polish produce the same effects of a volatile anesthetic
Opioid-related disorders
mu receptor agonist - examples: morphine, heroin, methadone
Endotracheal intubation indications
respiratory failure, apnea, LOC/GCS <8, rapid change in mental status, airway injury, airway compromise, high aspiration risk, trauma to larynx, surgery
Pre-oxygenation for endotracheal intubation
administer 100% oxygen for at least 3 minutes with NRB at 15+ L/min to increase safe apnea time to 8 minutes
MAC blade is _____ traumatic, but provides _____ of a view
Miller blade is _____ traumatic, but provides ______ of a view
ET tube selection
7.5-8 mm for women
8-8.5 mm for men
Rapid Sequence Intubation steps
- get all supplies organized
- administer induction agent (IV Etomidate, propofol, ketamine)
- administer paralytic (Succinylcholine, Rocuronium)
- Insert blade, visualize cords, advance ETT
- inflate balloon
- confirm placement
- secure ETT
types of intravenous line placement
peripheral
central
what to avoid in peripheral IV placement
distal to areas of infection/injuries/potential vascular disruption
avoid extremities with AV fistulas or grafts, or previous LN dissections
complications of IV
- infiltration
- thrombophlebitis
- phlebitis
- hypervolemia
- hematoma
- infection
peripheral IVs replacement timeline
usually every 72-96 hours
