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  • Meeting abstract
  • Open Access

The early management of pain in casualty wards

  • 1 and
  • 1
Critical Care20004 (Suppl 1) :P188

https://doi.org/10.1186/cc908

  • Published:

Keywords

  • Morphine
  • Visual Analogue Scale
  • Gout
  • Gastric Ulcer
  • Nasal Polyp

Full text

Objectives

Pain is often the main complaint of patients coming into casualty wards but its management is rarely initiated early. Pain management must be considered as an aspect of the general management of the patient coming into the emergency ward [1,3]. It is consequently essential to relieve the pain quickly while continuing the diagnosis [2]. The treatment of pain is a progressive process and there should be no hesitation in combining different drugs with a maximum analgesic benefit while controlling the analgesia in order to avoid secondary effects. The following protocol will allow rapid and reassuring analgesia.

Method

Upon arrival in the ward, the adult patient is dealt with by a nurse who evaluates the analgesic need using the Visual Analogue Scale (VAS). After the consent of the doctor by signing a standard protocol, proparacetamol (2 g IV) and diclofenac (75 mg IV) are administered every 6 and 12 h respectively, irrespective of the VAS level. If the VAS is greater than 3 in the half hour following the initial administration of proparacetamol and diclofenac, the analgesia is completed by subcutaneous morphine (the dose is defined on the written protocol in relation to the weight and age of the patient). This administration must be repeated with an interval of 4 h if the VAS is greater than 3. The contraindications for the different drugs must be respected: chronic renal insufficiency, arterial hypertension with heart failure and gastric ulcers for diclofenac; hepatic insufficiency, atopy, nasal polyps, asthma and eczema for proparacetamol; chronic respiratory insufficiency and drug addiction for morphine.

Results

The cases collected (n=200) show a demographic equivalence (45% women, 55% men) and an average age of 49 years. The distribution of the cases was mainly orthopedic (72%), with renal colic representing 9.6%. Other less common indications made up the remaining 18.4% (neuralgia, arthritis, knife wounds, gout, colitis). The Table shows the VAS over time, from admission up to 28 h (for 63 patients).

The average VAS on admission was 6.02± 2.06.

Conclusions

Using a simple standardized method this protocol allows effective and early management of pain with combined analgesia in a casualty ward.

Table

 

Average

Standard deviation

Quantity

% VAS >3

Hour 0 (H0)

6.02

2.06

73

88

H0+4

3.6

1.07

73

45

H0 +8

3.64

1.09

51

38

H0+12

3.55

1.05

48

32

H0+16

2.99

0.94

39

13

H0+20

2.97

1.05

31

13

H0+24

2.78

0.93

30

8

H0+28

2.48

0.85

20

4

Authors’ Affiliations

(1)
Ambroise Pare University Hospital, Mons, Belgium

References

  1. Berthier F, Potel G, Le Conte P, Tonze MD, Baron D: Comparative study of methods of measuring acute pain intensity in an emergency department. AM J Emerg Med 1998, 16: 132-136. 10.1016/S0735-6757(98)90029-8PubMedView ArticleGoogle Scholar
  2. Berthier F, Le Conte P, Garrei P, Potel G, Baron D: Analyse de la prise en charge de la douleur aiguë dans un service d'accueil et d'urgence. Réan Urg 1998, 7: 281-285. 10.1016/S1164-6756(98)80027-3View ArticleGoogle Scholar
  3. Blettery B, Bhrahim L, Honart D, Aube H: Les échelles de mesure de la douleur dans un service d'accueil des urgences. Réan Urg 1996, 16: 691-697. 10.1016/S1164-6756(05)80594-8View ArticleGoogle Scholar

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