Analgesia in Patients with Trauma in Emergency Medicine

Häske, David; Böttiger, Bernd W.; Bouillon, Bertil; Fischer, Matthias; Gaier, Gernot; Gliwitzky, B.; Helm, Matthias; Hilbert-Carius, Peter; Hoßfeld, Björn; Meisner, Christoph; Schempf, Benjamin; Wafaisade, Arasch; Bernhard, Michaël

doi:10.3238/arztebl.2017.0785

Cited by 48 publications

(39 citation statements)

References 100 publications

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“… 25 Safety of opioid-based protocols is ensured by vital signs monitoring, the availability of antidotes (naloxone), bag mask ventilation, and providers’ expertise in emergency procedures. 26 Moreover, even if opioid related complications, such as nausea, vomiting, hypoxia and hypotension, are reported as very low, a two-tier emergency system guarantees medical support in case of adverse events or unmanageable pain. 7 , 27–30 …”

Section: Discussionmentioning

confidence: 99%

“…25 Safety of opioid-based protocols is ensured by vital signs monitoring, the availability of antidotes (naloxone), bag mask ventilation, and providers' expertise in emergency procedures. 26 Moreover, even if opioid related complications, such as nausea, vomiting, hypoxia and hypotension, are reported as very low, a twotier emergency system guarantees medical support in case of adverse events or unmanageable pain. 7,[27][28][29][30] International experiences from other European countries such as Switzerland, Germany, and Denmark, as well as Australia and the United States, reported that paramedic or nurse analgesia projects are safe and effective, and could optimize treatment for a wider range of patients, particularly in rural and remote prehospital environments.…”

Section: Advantages Of Nurse-administered Analgesia In the Emergency Settingmentioning

confidence: 99%

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Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

Imbrìaco¹,

Rondelli²,

Maroni³

et al. 2021

JPR

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Background Acute pain is common among patients requiring assistance from prehospital emergency medical services (EMS). Nonetheless, the undertreatment of pain in this context remains a frequent phenomenon. Timely and effective analgesia is a crucial feature in emergency medicine. To ensure analgesia provision, prehospital paramedics and nurses can administer analgesics via standard operating protocols or under a physician’s remote supervision. Information about such protocols in Italian EMS is lacking. Objective Evaluation of the availability of nurse’s standard analgesia protocols in Italy’s prehospital EMS settings. Methods A cross-sectional online survey involved all 74 Italian emergency medical dispatch centres (EMDCs). Aside from descriptive statistics, we used χ 2 -analysis and Spearman-rank correlation to look for associations between geographical areas’ dependence upon independent variable categories and their correlations. Results Of all the 74 Italian EMDCs, 70 (94.6%) completed the survey, covering 100 provinces out of a total of 107 (93.5%). Operating nurses’ prehospital analgesia protocols are available in 46 provinces (46.0%). The availability of prehospital analgesia protocols is more extended in northern Italy EMDCs (n=30, 66.7%) than in central Italy (n=9, 42.8%) and southern Italy and islands (n=7, 20.6%). Morphine (76.1% for medical patients and 95.7% for trauma) and paracetamol (89.1% for both) are the most common drugs included in the prehospital analgesia protocols. Conclusion Despite international consensus on the necessity, efficacy, and safety of nurses’ prehospital analgesia provision, nurse-administered analgesia protocols are available in less than half of Italian provinces, with substantial differences between northern, central, and southern areas. These results indirectly indicate potential undertreatment of prehospital pain in Italy and yield practice improvements.

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Section: Discussionmentioning

confidence: 99%

Section: Advantages Of Nurse-administered Analgesia In the Emergency Settingmentioning

confidence: 99%

Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

Imbrìaco¹,

Rondelli²,

Maroni³

et al. 2021

JPR

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“…First, several studies were excluded as they did not offer clear methodology on how ketamine's analgesic effectiveness was evaluated. Resource limitation in prehospital medicine, as well as the fact that ketamine is often the preferred option in the hemodynamically unstable patient, 42 may account for the lack of documented pain intensity and adverse event monitoring. The lack of standardized measurement of outcomes does mean that a meta-analysis could not be appropriately performed.…”

Section: Discussionmentioning

confidence: 99%

Ketamine as a Prehospital Analgesic: A Systematic Review

Bansal

Miller

Ferguson

et al. 2020

Prehosp. Disaster med.

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Objective:Analgesia in the prehospital setting is an extremely important, yet controversial topic. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been commonly used in the prehospital setting, including recommendations by the US Department of Defense and by the Royal Australian College of Pain Medicine, despite the paucity of high-level evidence.Methods:Accordingly, a review of the literature was conducted using several electronic medical literature databases from the earliest available records to the time at which the search was conducted (October 2018).Results:The search strategy yielded a total of 707 unique papers, of which 43 were short-listed for full review, and ultimately, ten papers were identified as meeting all the relevant inclusion criteria. The included studies varied significantly in the prehospital context and in the means of administering ketamine. There was only low-grade evidence that ketamine offered a safe and effective analgesia when used as the only analgesic, and only low-grade evidence that it was as effective as alternative opioid options. However, there was moderate evidence that co-administration of ketamine with morphine may improve analgesic efficacy and reduce morphine requirement.Conclusions:Overall, ketamine as a prehospital analgesic may be best used in combination with opioids to reduce opioid requirement. It is suggested that future studies should use a standardized approach to measuring pain reduction. Future studies should also investigate short-term side effects and long-term complications or benefits of prehospital ketamine.

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“…Während die periphere Venenverweilkanüle immer noch den Standard in der Notfallmedizin darstellt [10], hat sich bereits in den vergangenen Jahrzehnten der intraossäre Zugang in der pädiatrischen Notfallmedizin etabliert [9]. Aus dieser Erfahrung hat sich die intraossäre Injektion auch bei Erwachsenen als erfolgreich erwiesen und ist zusammen mit der intranasalen Applikation von Medikamenten zu einer vielversprechenden und häufigen Alternative geworden [3][4][5][6].…”

Section: Einfach Und Praktisch: Anlage Venöser Portsysteme In Rettungunclassified

Einfach und praktisch: Anlage venöser Portsysteme in Rettungsdienst und Notaufnahme

Strobel

Kiele²,

Dorau

et al. 2021

Notfall Rettungsmed

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Analgesia in Patients with Trauma in Emergency Medicine

Cited by 48 publications

References 100 publications

Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

Ketamine as a Prehospital Analgesic: A Systematic Review

Einfach und praktisch: Anlage venöser Portsysteme in Rettungsdienst und Notaufnahme

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