Pain Management in Emergency Medicine

Abstract

In an emergency department, 60% of patients have an acute pain. The struggle against acute pain is a public health priority. The objectives of the acute pain management are its recognition, an adapted treatment, a systematic and regular assessment of pain intensity. The methods of intensive pain assessment have to be adapted to the patient. The three recommended self-evaluation scales are Visual analogic scale, Numeric rating scale and Simple verbal scale. A caregiver assessment of patient's pain will be used for no communicating patients and the Algoplus scale seems currently to be the more adapted. Analgesia has to be early and adapted to the patient. Care protocols validated by all the emergency department staff are essential. The treatment principle is the multimodal analgesia, which could include physical, psychological and drugs ways. Morphine remains the reference opioid and its prescription means a specific patient monitoring. The assessment of ketamine as a coanalgesic for emergency setting is on the way. Regional anaesthesia could be used in two circumstances: trauma limbs and facial trauma. It has to be done within the limits of the guidelines. In conclusion, the efficiency of pain management in emergency setting is based on its recognition and protocols adapted to pathology and patient. The caregivers support for these protocols is a determining factor for the success of the quality assurance procedure about pain. (copyright) 2007.