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An Evidence-Based Approach To Traumatic Pain Management In The Emergency Department (Trauma CME) - $30.00
August 2012 (Volume 14, Number 8)
This issue includes 4 AMA PRA Category 1 CreditsTM, 4 ACEP Category 1 credits, 4 AAFP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.
Christopher R. Tainter, MD, RDMS
Assistant Residency Director, Director of Medical Student Education, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
Ashika Jain, MD, RDMS
Department of Emergency Medicine and Trauma Critical Care, Kings County Hospital Center, Brooklyn, NY
Monica K. Wattana, MD
Fellow, Emergency Oncology/Pain Management, The University of Texas MD Anderson Cancer Center, Houston, TX
Painful traumatic injuries account for a large portion of emergency department visits. Injuries may occur through various mechanisms, and many patient and provider factors affect the success of treatment. Not all injuries or patients should be treated in exactly the same fashion, and an understanding of these factors is important to providing optimal care. Medications, management strategies, and methods of evaluation have been studied with varying depth and success. Regional anesthetic techniques and nonpharmacologic means can help minimize the use of systemic agents that may have unwanted side effects. Diagnostic evaluation should not detract from symptomatic treatment. This evidence-based review summarizes the pathophysiology, historical factors, diagnostic strategies, and demographics that influence the experience of pain and provides recommendations for a variety of treatment options.
Excerpt from issue
A 65-year-old man with a history of COPD on home oxygen presents to your busy ED with an injury to his right hand from a fall. He states that he was walking across his living room and tripped over the oxygen tubing. As he tried to catch himself on a nearby table, he felt a painful “pop” in his hand. He denies any other injuries or pain, did not hit his head, and had no loss of consciousness or vertigo. In addition to his COPD, he has a history of coronary artery disease, hypertension, and smoking. His vital signs include a normal pulse rate and normal blood pressure. He is breathing 20 times per minute, and his oxygen saturation is 93% on 2 liters of oxygen by nasal cannula (which he uses at home). He has scattered expiratory wheezing, but he appears in no distress. You notice an obvious rotational deformity with localized swelling of his right hand. The remainder of his examination is unremarkable. He is currently experiencing minimal pain at rest, but he is unable to tolerate any movement of his hand. An x-ray shows an angulated fracture of the fifth metacarpal, which will require reduction. His family is concerned about the risks of medication you might consider because of his other medical problems. You are concerned too, since the last thing you want to do is complicate this patient’s care.