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Traumatic Pain Management… July 25, 2012

Posted by Andy Jagoda, MD in : Drugs & Emergency Procedures, General Emergency Medicine, Trauma , trackback

A 35-year-old female who was the restrained driver in a front-impact motor vehicle collision arrives. Her airbag deployed, and there was significant damage to her car. The paramedics report tachycardia to 120 beats/minute; her other vital signs are normal. Your examination reveals a young woman in pain, with a patent airway, equal breath sounds, strong distal pulses, and tenderness to palpation in her abdomen. She has a band-like ecchymosis across her chest wall and abdomen, consistent with placement of a seat belt. She is neurologically intact and is able to report that she did not hit her head or lose consciousness. She has no other tenderness or deformities. After reporting a normal fingerstick glucose and negative pregnancy test, the nurse asks you if you would like to order something for pain; the answer is yes, but you consider the risk of lowering her blood pressure or changing her exam findings, and you wonder what the safest strategy might be.

What do you do?

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Comments»

1. Dr.Adel Noman - August 2, 2012

patient with abdominal trauma with pain can managed with mild analgesic drugs like paracetamol with small dose of morphine ,but we should not give NSAIDrug .after discussion with surgeon.
patient need close follow up(including Vital signs+U/S Exa or if need to CT Scan) and examination when we giving analgesic

2. Dr. Rob Oelhaf - August 4, 2012

Pain is important to address in the setting of trauma. I think opiates are less likely to drop blood pressure in this case than the blood loss from what I presume is intraabdominal injury. Parenteral paracetamol is a thought but I personally have never had it on formulary to my knowledge.

3. Nasser - August 5, 2012

I’d put 2 wide bores canulas, and keep an IVf KVO ,, will order 2 pills of Tylenol and 0.5mg SL Ativan … Will wait for response while putting him on 3 L of O2…

4. Elzer Fuller - August 7, 2012

With abdominal pain following a traumatic event, consider splenic rupture…would use 1to 2 mg Morphine….if BP drops, the effects of morphine are easily reversible using narcan. Would also start 2 large bore IV’s and give NS or LR to support BP until diagnostic studies and Surgery consult can be obtained

5. DR SHAHRAM DAVOODI - September 3, 2012

About this case:
tachycardia is important sing of pre shock state, and we are attention to band-like ecchymosis across her chest wall and abdomen,and tenderness to palpation in her abdomen before use analgesic
order
in PH .EX is important check
1,cervical tenderness & cervical tenderness ,cervical X.RAY graphy
2,check breath & heart sound
3, check orthoastatic change
OREDER
NPO
CONT V/S &I/O
IV LINE
CERVICAL X RAY LATERAL
CXR
ABDOMINAL & PLEVIC X RAY
FAST SONOGRAPHY
CBC & BG &RH .U/A
FOLLY FIXATION
NG TUBE FIXTION & DECOMPRESSION
SERUM N/S 1000 CC IV INFUSION FREE
PARACETAMOL IV INFUSION
SURGICAL CONSULT

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