Field Care Audit presented at Redwood Memorial Hospital

1. I Wanna New Drug:
Treating the 5th Vital Sign
Veronica Bonales, M.D.
CEPAmerica Emergency Medicine
Humboldt County EMCC PC

2. Pain Assessment: or How We See Our
Patients...

3. Pain Management
Studies show EMS & ED personnel fail to recognize and
properly treat pain
Oligoanalgesia
Undertreatment of pain

4. Pain Management
Reasons for oligoanalgesia
Underestimation of patient’s pain
Patient not asked
Patient’s level of pain not believed

5. Pain Management
How can we improve...?
Make pain the Fifth vital sign
Record interventions and reassessment

6. Assessment Tools: or How do Patients Rate
Their Pain...?

9. Pain Management
Pain travels along nocioceptors from the peripheral to the
central nervous system to be recognized by the brain
Modified as it travels along the pathways
Interpretation includes psychological, physiological,
emotional and behavioral dimensions
Cannot infer pain level from degree of damage

11. Pain Management
Patient self-reporting is “the most reliable indicator of the
existence and intensity of pain.”

12. Pain Management
Techniques of Three Pain Rating Scales
Numerical rating scale (NRS)
(patients verbally requested to rate their pain)
Rate your pain from 0 (no pain) to 10 (unbearable pain)
Verbal rating scale (VRS)
(five pain levels are indicated in large print on a sheet given to the patient: no pain, mild pain, moderate pain, severe pain, unbearable pain)
Choose the adjective best corresponding to your pain level.
Visual analog scale (VAS)
(A 100-mm rule with a movable cursor: ‘‘no pain’’ is written at the left end of the horizontal line along which the cursor is moved, and
‘‘maximal pain’’ at the right end) Move the cursor along the line to indicate the intensity of your pain. The left end of the line represents ‘‘no
pain’’ and the right end the most intense pain imaginable, i.e., excruciating and unbearable pain.

13. Pain Management
What do we need to do...?
Make sure using a pain scale that will be reliable (NRS)
Children under 8 cannot self-report, need to be vigilant of
their behavior to assess pain

14. Analgesia: or Who to Give Pain Medications
To

15. Pain Management
Myth of withholding pain medication for abdominal pain
Myth of morphine being unsafe
Myth of giving treatment delays transport time
Consider analgesia in all patients with isolated extremity
trauma, hip fractures and burns

16. Pain Management
Relief of patient’s pain starts with:
Use of appropriate wording and distraction away from
painful stimuli
Keeping parents near children to reduce distress
Immobilize fractures, elevate extremities, apply ice
packs, pad spinal immobilization devices

17. Pain Management
Make pain the fifth Vital Sign
Don’t judge patients
Don’t infer level of pain based on degree of injury
Assess children under 8 by behavior
Don’t wait until transfer to start alleviating patients pain

18. Life in the E.D.

19. docmontey@yahoo.com
www.slideshare.net/docmontey