Advanced forms of pain relief

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FlashCards sobre Advanced forms of pain relief, criado por Elizabeth Then em 13-06-2018.
Elizabeth Then
FlashCards por Elizabeth Then, atualizado more than 1 year ago
Elizabeth Then
Criado por Elizabeth Then mais de 6 anos atrás
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Resumo de Recurso

Questão Responda
pain definition unpleasant sensory and emotional experience associated with actual or potential tissue damage, described in terms of such damage
type of pain acute, chronic, nociceptive, neuropathic
acute pain recent onset, limited duraton identifiable cause, indicayes injury and illness, predicatable course
chronic or persistent pain persistent, cause is often obscure, sensitisation of noiceptors or nerves, poorly responsive to therapy, including opioids, unpredictable
Nociceptive pain most common in acute settings stimulation of nociceptors as result of tissue damge pain characteristics - somatic = sharp, ot, stinging visceral = dull, crampy
neuropathic pain dysfunction in nervous systen - nerve pain e.g. amputation of limb, burning, pulsing, shooting, tingling, hyperalgesia (increased pain with painful stimuli) , allodynia (pain with non-painful stimuli)
prolonged injury response hyperglycaemia - increased risk of infection, length of stay increase in fatty acids - myocardial o2 consumption increase in coagulation - increase DVT/PE increase muscle protein breakdown - decrease wound healing decrease immune function - increase infection
prolonged sympathetic reponse increase heart rate, BP, myocardial oxygen, ischaemia, decreased GI motility - ileus
major complications of bed rest Increase pulmonary complications, decrease lung volumes, hypoxaemia, increase thromboembolism goal: mobilise and cough comfortably
Measuring pain subjective - only patient knows
assessing pain at rest and movement - reassess after analgesic administration
FAS assessment of function, the ability to deep breathe/cough, participate in physio a - no limitation due to pain b - mild limitation c - unable to complete activity
non-pharmacological management rest, position, elevation, compression, reaasurance, explanation, expectation
Pharmacological management opioids- IV, PCA, oral, SC non- opioids - paracetamol, NSAIDS, ketamine, anticonvulsant, antidepressants neuraxial - epidural, intrathecal regional
morphine least lipid soluble - slower onset of action, longer duration active metabolites - M3G M6G renal excretion - caution with elderly SR - kapanol, MS contin
Fentanyl highly lipid soluble - fast onset, shorter action no active metabolites - safer for renal impairment and elderly SR - transdermal - durogesic patch
Oxycodone first line opioid semi - synthetic opioid derivative of thebaine not codiene no harmful metabolites - suitable for elderly SR - oxycontin, targin
Tramadol synthetic - opioid like analgesic combined effect SSRI reduces pain transmission and perception active metabolite - caution elderly lower risk of sedation and resp depression lower risk of constipation
Adverse effect of opioids nausea and vomiting -- antiemetics Pruritis - naloxone, antihistamines urinary retention constipation sedation and resp depression
opioid effect on resp system decreased rate, rhythem irregular, decrease tidal volume, increase co2, sedation, depression of upper airway tone and obstruction resp rate is a late and unreliable sign increasing sedation is a better sign
sedation scores o- wide awake 1- easy to rouse, remains awake 2- easy to rouse but cannot stay awake 3 - difficult to rouse (severe resp depression)
Naloxone opioid antagonist half life 30-60 minutes
Adjunvants paracetamol, NSAIDS, ketamine, anticonvulsants, antidepressant are all opioid sparring lead to reductoin of opioid required, fewer side effects
Ketamine blocks NMDA receptors in the spinal cord side effects : vivid dreams, hallucinations
dermatome area of skin that is mainly supplied by a single nerve which originates in the epidural space
epidural complications systemic toxicity tingling, umbenss, metallic taste, light headed, coma, convulsions treatment: stop infusoin, resp and cario support

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