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<< Pain Management in the Emergency Department

ED Management

Initial stabilization

Patients presenting to the ED in acute pain often look quite distressed. As mentioned previously, visceral pain is often accompanied by autonomic symptoms such as nausea/vomiting, hypotension, bradycardia, and sweating. Initial stabilization requires immediate assessment of the presenting symptoms and vital signs and consideration for placement of an IV for titration of pain medication. The type of pain dictates what is needed for stabilization; e.g., substernal chest pain in a diabetic would require an IV, oxygen and monitor, while a recurrent tension type headache might require nothing more than intramuscular medication.

An assessment and documentation of pain is a fundamental component of triage. While many acutely painful processes are not life-threatening, severe pain mandates a more urgent triage scoring and placement in the ED. Since early pain management may in fact break the cycle and limit the extent of pain ultimately experienced by the patient, early pain control is recommended. In addition, early pain control can often facilitate obtaining an accurate history and physical examination, see Table 7.