Pain is vital in resuscitation in trauma

Abstract

Implementation of the ATLS algorithm has remarkably improved the resuscitation of trauma patients and has significantly contributed to the systematic management of multi-trauma patients. However, pain remains the most prevalent complaint in trauma patients, and can induce severe complications, further deterioration of health, and death of the patient. Providing appropriate and timely pain management to these patients prompts early healing, reduces stress response, shortens hospital Length of Stay (LOS), diminishes chronic pain, and ultimately reduces morbidity and mortality. Pain has been proposed to be evaluated as the fifth vital sign and be recorded in the vital sign charts in order to emphasize the importance of pain on short- and long-term outcomes of the patients. However, although the quality of pain treatment seems to be improving we believe that pain has been underestimated in trauma. This article aims to provide evidence for the importance of pain in trauma, to support its management in the emergency setting and the acute phase of patients’ resuscitation, and to emphasize on the necessity to introduce the letter P (pain) in the ATLS alphabet.

A Comprehensive Assessment of The Eight Vital Signs

“…Since Campbell's initial recommendation, the words fifth vital sign associated with pain frequently appeared in the literature, with debate about whether pain should be considered the fifth vital sign . Some authors defended its adoption (30,(33)(34)(35)(36)(37), while others maintained contrary views (18,(38)(39)(40). Those who support pain as a vital sign argue that it is a subjective self-reportable valuable measurement; few patients become addicted to opioids secondary to pain treatment, and at least 75% of postoperative pain is not adequately treated (30,33).…”

“…Those who support pain as a vital sign argue that it is a subjective self-reportable valuable measurement; few patients become addicted to opioids secondary to pain treatment, and at least 75% of postoperative pain is not adequately treated (30,33). Saranteas et al recommended that "P" for pain should be included in the Advanced Trauma Life Support (ATLS) algorithm (34). Opposing views argue that pulse oximetry had already been designated the fifth vital sign and that pain is a symptom and not a sign (18).…”

Orthopaedic cardiac considerations in emergency

“…In conclusion, written consent must be obtained by all patients or their relatives after a thorough analysis of the procedure and the potential cardiac risks and complications. The medical team should be accountable to acknowledge the risks stemming from the medical history of the patient relative to the severity of the orthopaedic surgery [40][41][42][43][44][45][46][47][48]. Well trained and experienced cardiologists, anesthesiologists and orthopaedic surgeons should harmonically cooperate and undertake successfully all the difficult cases.…”

A gestão da dor aguda na pessoa vítima de trauma: Uma revisão integrativa da literatura / The management of acute pain in the trauma victim: An integrative review of the literature

“…Por ausência de formação e sensibilidade para a temática, a dor aguda na pessoa vítima de trauma é negligenciada, sendo comum a oligoanalgesia (Saranteas et al, 2019;. Na prática diária, a dor é interpretada como inerente ao trauma, admitindo-se como condição da pessoa vítima de trauma (Saranteas et al, 2019).…”

“…A gestão eficaz da dor aguda requer valorização, avaliação e tratamento, farmacológico e não-farmacológico (Allen et al, 2018;Elkbuli et al,2020;Sullivan et al,2016). Na pessoa vítima de trauma, a intervenção especializada de enfermagem revela-se fulcral para o desenvolvimento de uma estratégia multimodal, que combina abordagem farmacológica e nãofarmacológica, com impacto no outcome da pessoa em situação crítica (Saranteas et al, 2019).…”