The “Oligoanalgesia Problem” in the Emergency Care

Calil, Ana Maria; Pimenta, Cibele A. de Mattos; Birolini, D

doi:10.1590/s1807-59322007000500010

Cited by 25 publications

(33 citation statements)

References 11 publications

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“…A produção de substâncias algogênicas como prostaglandina e serotonina, em situações de lesões por trauma, vão diminuindo com o passar dos dias e da cicatrização da lesão tecidual (11)(12)16) . Desse modo, a frequente avaliação da dor, assim como a efetividade da ação dos fármacos, deverá ser realizada como um cuidado importante da equipe de saúde, não esquecendo que a dor é considerada como o quinto sinal vital (2) . Dos 42 pacientes que foram medicados, apenas 18 receberam fármacos mais de uma vez (em dois momentos) e 24 apenas uma única vez.…”

Section: Eav -Esc Ala An Aló G Ica VI Su Al; Niss = New In Ju Ry Se Vunclassified

“…Embora freqüente, pouca atenção tem sido concedida ao controle álgico do traumatizado e o tema é insuficientemente pesquisado em nosso meio (2) . As repercussões orgânicas do processo álgico intenso são subestimadas por médicos e enfermeiros; a desinformação sobre as técnicas disponíveis e sobre a farmacologia das drogas analgésicas; condições do local do acidente e do setor de emergência adversas a esse tipo de tratamento e a administração precoce de analgésicos podendo mascarar um indício valioso para o diagnóstico etiológico são os principais motivos citados na literatura para o inadequado controle da dor no setor de emergência (2)(3) . Dor é uma experiência sensorial e emocional desagradável, associada a uma lesão tissular real ou potencial, e descrita em termos de tal dano (4) .…”

Section: Introductionunclassified

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Importância da avaliação e padronização analgésica em serviços de emergência

Calil

Pimenta

2010

Acta paul. enferm.

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RESUMOObjetivos: Conhecer a medicação antiálgica utilizada em pacientes que sofreram acidentes de transporte, o padrão analgésico e pontuar a intensidade da dor. Métodos:Estudo descritivo, exploratório e longitudinal com abordagem quantitativa, que abrangeu 100 pacientes envolvidos em acidentes de transporte admitidos para tratamento em hospital referência para trauma. Resultados:A dor foi identificada em 90,0% dos pacientes, sendo as de forte e média intensidade as mais frequentes; não se encontrou prescrição antiálgica em 48% dos casos. Maior uso medicamentoso foi encontrado em vítimas com lesões em membros e nos sete casos em que a dor foi totalmente aliviada, 5 (66,7%) foram utilizados opióides. Conclusão: A dor é um fenômeno comum associado ao trauma com sub-tratamento e sub-avaliação em nosso meio, e o uso de opióides para dores reconhecidamente muito intensas ainda é um recurso pouco utilizado na emergência, mesmo em pacientes hemodinamicamente estáveis e com Escala de Coma de Gasglow=15. Descritores: Dor; Ferimentos e lesões; Analgesia; Serviços médicos de emergência; Avaliação. ABSTRACT Objectives:To describe the types of analgesic medication used by patients who had automobile accidents and to identify standardization of analgesic medication and measurement of pain intensity. Methods: This was a descriptive longitudinal quantitative study with 100 patients who had automobile accidents from a trauma designated hospital. Results: The majority of patients (90.0%) reported having pain. High and moderate levels of pain intensity were the most commonly reported by the patients. There was no prescription of analgesic medication for 48% of the patients. Patients with limb lesions received more analgesic medication than those with other types of lesions. Among 7 patients who had complete pain relief, 5 of them (66.7%) received opioid medication. Conclusions: Pain is a common symptom associated with inadequate evaluation and management. The use of opioid medication to relief high intensity pain in trauma patients in emergency services is not a common practice even for those patients who are hemodynamically stable and having a score of 15 on the Glasgow Coma Scale. Key Words: Pain, Wounds and Lesions; Analgesia; Medical Emergency Services; Evaluation. RESUMENObjetivos: Conocer los medicamentos antiálgicos utilizados en pacientes que sufrieron accidentes de transporte, conocer el estándar analgésico y dar puntajes a la intensidad del dolor. Métodos: Estudio descriptivo, exploratorio y longitudinal con abordaje cuantitativo, que comprendió 100 pacientes que sufrieron accidentes de transporte y fueron admitidos para tratamiento en un hospital de referencia para tratamiento de traumas. Resultados: El dolor fue identificado en 90,0% de los pacientes, siendo los dolores más frecuentes los de fuerte y media intensidad; no se encontró prescripción antiálgica en 48% de los casos. El mayor uso medicamentoso fue encontrado en víctimas con lesiones en miembros y entre los siete casos en que el dolor fue totalmente aliviado, ...

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Section: Eav -Esc Ala An Aló G Ica VI Su Al; Niss = New In Ju Ry Se Vunclassified

Section: Introductionunclassified

Importância da avaliação e padronização analgésica em serviços de emergência

Calil

Pimenta

2010

Acta paul. enferm.

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“…Esses achados podem refletir os resultados negativos de estudos que apontaram que a dor, seja ela aguda ou crônica, é subdiagnosticada, mal avaliada, subtratada, com baixa resolutividade e por vezes negligenciada em vários níveis de atenção à saúde [4][5][6] .…”

Section: Introductionunclassified

Conhecimento dos acadêmicos e profissionais da fisioterapia sobre dor: uma revisão sistemática

et al. 2017

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Estudos demonstram que acadêmicos e profissionais da fisioterapia apresentam limitações no conhecimento sobre diversos aspectos do tema "dor". Isso pode implicar em abordagens inadequadas e em maior sofrimento dos pacientes. Assim, objetivou-se revisar estudos que investigaram o conhecimento de acadêmicos e profissionais da fisioterapia sobre dor, bem como os que propuseram estratégias para modificar tal conhecimento. Trata-se de uma revisão sistemática, e foram consultadas as bases de dados EBSCOhost, LILACS, PubMed, REDALYC e SciELO, por meio do cruzamento das palavras-chave: "pain", "knowledge", "education", "curriculum", "physical therapy specialty" e os seus correspondentes em português. ABSTRACTStudies show that physical therapy students and professionals have limited knowledge about various aspects of the subject "pain". This may result in inadequate approach and increases the patients' suffering. Thus, it was aimed to review studies that investigated the physiotherapy students' and professionals' knowledge about pain, as well as to propose strategies for changing it. This is a systematic review in which EBSCOhost, LILACS, PubMed, REDALYC and SciELO databases were consulted by crossing the following keywords and its matching terms in Portuguese: "pain", "knowledge", "education", "curriculum", "physical therapy specialty". Crosssectional or experimental studies addressing knowledge about pain clinical and pathophysiological aspects, and management were eligible. Studies that tested strategies to modify knowledge about pain were also qualified. Screening by title and abstract resulted in 84 studies. However, only five studies were included, which analyzed the knowledge about general aspects of pain and were published between 2003 and 2016. Only 60% of studies investigated volunteers from the field of physical therapy, whereas 100% of them had their knowledge verified in self-reported questionnaires. Four studies used validated questionnaires. Only 20% of them tested strategies to modify the knowledge about pain. The results of this review are that the topic "pain" is addressed as sub-topic only. Although it allows learning, it is not enough to ensure it. Physical therapy professionals are inconsistent as to theoretical knowledge and practice on pain management and human assistance. Teaching and learning strategies may improve students' knowledge about pain.

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“…Emergency physicians care for patients with pain on an extremely frequent basis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Th e prevalence of pain as the presenting complaint of patients seeking eme rgen cy department (ED) care ranges from 38 % [3] to as high as 78 % [1].…”

Section: Introductionmentioning

confidence: 99%

“…As a result, evidence-based use of analgesics should be a foundational skill of emergency physicians. However, the literature consistently reports that emergency physicians are ofte n poor at treating pain [1,2,8,13,14,16,19,20] . Notwithstanding the prevalence of pain in the ED, many patients often report that their pain was no t pr oper ly t reated [3,7,20].…”

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confidence: 99%

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Lipp

Dhaliwal

Lang

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Emergency physicians care for patients with pain on an extremely frequent basis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Th e prevalence of pain as the presenting complaint of patients seeking eme rgen cy department (ED) care ranges from 38 % [3] to as high as 78 % [1]. As a result, evidence-based use of analgesics should be a foundational skill of emergency physicians. However, the literature consistently reports that emergency physicians are ofte n poor at treating pain [1,2,8,13,14,16,19,20] . Notwithstanding the prevalence of pain in the ED, many patients often report that their pain was no t pr oper ly t reated [3,7,20]. I n addi tion to a compromised patient experience, sub-optimal treatment of pain will result in decreased department fl ow, increased wait times, more return visits to the ED, and increased hospitalization rates.Very few evidence-based resources and guideli nes exis t to inform emergency physicians on how to treat pain. One recent guideline on acute pain management compiled by the college of Anaesthetists of Australia and New Zealand [21] was focused primarily on treating pain perioperatively and did not include stratifi ed or graded recommendations based on the literature, highlighting the paucity of emergency medicine-specifi c guidance. Emergency physicia ns need an eff ective, evidenced-based approach to analyze and apply the options available for acute pain management.Th e objective of this article is to synthesize and evaluate the quality of medical literature surrounding analgesia delivery in the adult ED using the Grading Assessment, Development and Evaluation (GRADE) framework. We further strived to provide emergency physicians with graded recommendations upon which analgesics should be used to treat adults with acute pain in the ED. Question formulationPrior to searching the literature we developed seven clinically-oriented questions based on a scoping of the literature and a review of locally utilized ED analgesic order sets. Th is initial surveying of medical literature and our local practice environment allowed us to identify the most commonly prescribed intravenous and oral analgesics used in adult EDs in our health care region.We then used the patient-intervention-comparisonoutcome (PICO) approach to develop our seven research questions (Table 1). Th is approach has been adopted by many authors of systematic reviews and guideline panels, including the Internati onal Liaison Committee on Resuscitation (ILCOR) and the American College of Chest Physicians (ACCP) [22][23][24]. It involves identifying a specifi c population or setting to which recommen dations may be applied. Subseq uently each question compares two specifi c management strategies (intervention and comparison). Fi nally, we defi ned important patient oriented outcomes (e. g., change in pain) as well as any adverse eff ects of the medication or other safety concerns.All seven draft questions were reviewed and revised through an iterative process involving all authors. Th ese seven cl...

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The “Oligoanalgesia Problem” in the Emergency Care

Cited by 25 publications

References 11 publications

Importância da avaliação e padronização analgésica em serviços de emergência

Importância da avaliação e padronização analgésica em serviços de emergência

Conhecimento dos acadêmicos e profissionais da fisioterapia sobre dor: uma revisão sistemática

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

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