Intravenous ketamine as an analgesia in prehospital adult trauma patients

2022 ◽  
Vol 14 (1) ◽  
pp. 26-36
Author(s):  
Anya Critchley
Keyword(s):  
Pain Relief ◽  
Major Trauma ◽  
Trauma Patients ◽  
First Line ◽  
Exclusion Criteria ◽  
Adequate Pain Relief ◽  
Research Questions ◽  
Effective Pain Relief ◽  
Intravenous Ketamine

Background: Prehospital traumatic pain is common, but the quality of pain management in these patients is poor. Current practice recommends morphine as the first-line analgesia in major trauma but this carries high risks and is often contraindicated. Alternative paramedic-administered analgesia does not provide adequate pain relief or may be contraindicated. As a result, many patients remain in pain. Analgesic ketamine is used safely and effectively in international civilian and military settings and by paramedics with additional training, education and qualifications. Aim: The study had two aims. Namely, these were to find out whether intravenous ketamine: provides effective relief of prehospital traumatic pain in adults; and is safe for prehospital administration by non-specialist paramedics. Method: Three databases, CINAHL, MEDLINE and AMED, were searched to identify articles published between 2009 and 2021. Exclusion criteria were applied and results subjected to critical appraisal and evaluation. Findings: Four studies were included in the review. Two themes were identified for thematic analysis: therapeutic effectiveness; and the safety of IV ketamine administration by paramedics. The evidence drew predominantly homogenous conclusions, but was substandard regarding external validity, which limited the quality of these conclusions. Conclusion: Ketamine provides effective pain relief in line with morphine and is safe for paramedics to administer. However, clear gaps in the evidence mean the research questions are not fully answered, so changes to current paramedic practice cannot be recommended.

scholarly journals Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial

2020 ◽  
Vol 9 (8) ◽  
pp. 2420
Author(s):  
Helmuth Tauber ◽  
Nicole Innerhofer ◽  
Daniel von Langen ◽  
Mathias Ströhle ◽  
Dietmar Fries ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Platelet Transfusion ◽  
Major Trauma ◽  
Coagulation Factor ◽  
Trauma Patients ◽  
First Line ◽  
Platelet Counts ◽  
Randomized Controlled ◽  
Coagulation Factor Concentrates ◽  
Haemostatic Resuscitation

Although platelets play a central role in haemostasis, the dynamics of platelet counts during haemostatic resuscitation, the response to platelet transfusion, and effects on clinical outcome are poorly described for trauma patients. As a sub-study of the already published randomized controlled RETIC Study “Reversal of Trauma-induced Coagulopathy using First-line Coagulation Factor Concentrates or Fresh-Frozen Plasma” trial, we here analysed whether the type of first-line haemostatic resuscitation influences the frequency of platelet transfusion and determined the effects of platelet transfusion in coagulopathic patients with major trauma. Patients randomly received first-line plasma (FFP) or coagulation factor concentrates (CFC), mainly fibrinogen concentrate. In both groups, platelets were transfused to maintain platelet counts between 50 and 100 × 109/L. Transfusion rates were significantly higher in the FFP (n = 44) vs. CFC (n = 50) group (FFP 47.7% vs. CFC 26%); p = 0.0335. Logistic regression analysis adjusted for the stratification variables injury severity score (ISS) and brain injury confirmed that first-line FFP therapy increases the odds for platelet transfusion (odds ratio (OR) 5.79 (1.89 to 20.62), p = 0.0036) and this effect was larger than a 16-point increase in ISS (OR 4.33 (2.17 to 9.74), p = 0.0001). In conclusion, early fibrinogen supplementation exerted a platelet-saving effect while platelet transfusions did not substantially improve platelet count and might contribute to poor clinical outcome.

scholarly journals Use of Artra and Artra MSM Forte in osteoarthritis of the large joints and lowback pain

2019 ◽  
pp. 96-100
Author(s):  
E. P. Sharapova ◽  
L. I. Alekseeva
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
International Organizations ◽  
Joint Pain ◽  
Common Symptom ◽  
First Line ◽  
Knee Oa ◽  
Concomitant Medications ◽  
Lowback Pain

Knee and hip joint pain is the first and most common symptom that forces a patient to visit the doctor. Osteoarthritis (OA) treatment is aimed «primarily» at managing symptoms of the disease, i.e. reducing pain, improving the functional state of the joints, and finally at improving the patients’ quality of life. The Russian and international organizations have developed numerous guidelines for the treatment of OA, which include non-pharmacological and pharmacological methods, among which symptomatic slow-acting drugs are of special interest. These drugs are currently recommended to prescribe as the first-line drugs to treat OA. Analgesics and NSAIDs that rarely cause adverse effects, especially in older people and in patients with co-morbidities, who receive concomitant medications, are the most commonly prescribed medications for pain relief. This creates a problem when the drugs affect one another’s exposure and can limit the prescription of a range of drugs, which determines an increase in interest in other drugs called sustained-release symptomatic drugs, which are widely recognized in arthrology.The article presents the results of studies of Artra and Artra MSM Forte in patients with hip and knee OA, which were conducted in Russia.

Sequelae of Major Trauma Patients with Maxillofacial Fractures

2020 ◽  
pp. 000348942095873
Author(s):  
Lasse Østrup Petersen ◽  
Emil Ørskov Ipsen ◽  
Ulrik Ascanius Felding ◽  
Christian von Buchwald ◽  
Jacob Steinmetz
Keyword(s):  
Clinical Assessment ◽  
Major Trauma ◽  
Facial Nerve Paralysis ◽  
Trauma Patients ◽  
Initial Examination ◽  
Nerve Paralysis ◽  
Sensory Deficits ◽  
Facial Contour ◽  
Maxillofacial Fractures

Objectives: Sequelae after maxillofacial fractures are frequent and may affect the patient’s quality of life. This study examined sequelae associated with maxillofacial fractures of severely traumatized patients focusing mainly on nerve injuries. Methods: A retrospective study including trauma patients with relevant facial fractures admitted to our Trauma Center in the period 2011-2016. Presence of posttraumatic maxillofacial sequelae was identified by examining the medical records of the included patients. Focusing on facial sensory deficits and facial nerve paralysis, but also comprising data on diplopia, blindness, malocclusion, trismus, eye globe malposition, flattening of the malar, facial contour changes, and wound infections. Results: Two-hundred-seventy-five severely traumatized patients were included, comprising 201 men (73%), with a median age of 40 years and ISS of 20. 163 (59%) patients only had assessments within 3 months from trauma of which 79 patients (48.5%) had facial complications at initial examination, mostly malocclusion and trismus. Most patients in this group had no or only minor sequelae at their last clinical assessment, mainly being sensory deficits. 112 (41%) patients had assessments both within and beyond 3 months of which 73 patients (65.2%) had facial complications at initial examination, while 91 patients (81%) had reported sequelae within 3 months decreasing to 47 patients (42%) at their last clinical assessment beyond 3 months from trauma, mostly sensory deficits. An improvement of most sequelae was observed. Conclusion: Objective sequelae were found to be quite common after maxillofacial fractures in severely traumatized patients, especially sensory deficits. However, most of the addressed sequelae seemed to improve over time.

scholarly journals Efficacy, tolerability and acceptability of oxycodone for cancer-related pain in adults: an updated Cochrane systematic review

2018 ◽  
Vol 8 (2) ◽  
pp. 117-128 ◽  
Author(s):  
Mia Schmidt-Hansen ◽  
Michael I Bennett ◽  
Stephanie Arnold ◽  
Nathan Bromham ◽  
Jennifer S Hilgart
Keyword(s):  
Pain Relief ◽  
Adverse Events ◽  
Immediate Release ◽  
Evidence Base ◽  
First Line ◽  
Strong Opioids ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Event Rates

ObjectivesTo assess the efficacy, tolerability and acceptability of oxycodone for cancer pain in adultsMethodsWe searched CENTRAL, MEDLINE, MEDLINE In-Process, Embase, SCI, Conference Proceedings Citation Index-Science, BIOSIS, PsycINFO and four trials registries to November 2016.ResultsWe included 23 randomised controlled trials with 2144 patients analysed for efficacy and 2363 for safety. Meta-analyses showed no significant differences between controlled-release (CR) and immediate-release oxycodone in pain intensity or adverse events but did show significantly better pain relief after treatment with CR morphine compared with CR oxycodone. However, sensitivity analysis did not corroborate this result. Meta-analyses of the adverse events showed a significantly lower risk of hallucinations after treatment with CR oxycodone compared with CR morphine, but no other differences. The remaining studies either compared oxycodone in various formulations or compared oxycodone to different alternative opioids. None found any clear superiority or inferiority of oxycodone in pain relief or adverse events. The quality of this evidence base was limited by the high/unclear risk of bias of the studies and the low event rates for many outcomes.ConclusionsOxycodone offers similar levels of pain relief and adverse events to other strong opioids. However, hallucinations occurred less with CR oxycodone than with CR morphine, but the quality of this evidence was very low, so this finding should be treated with utmost caution. Our conclusions are consistent with other reviews and suggest that oxycodone can be used first line as an alternative to morphine. However, because it is cheaper, morphine generally remains the first-line opioid of choice.

scholarly journals Regular feedback on inter-hospital transfer improved the clinical outcome and survival in patients with multiple trauma: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chih-Jung Wang ◽  
Tsung-Han Yang ◽  
Kuo-Shu Hung ◽  
Chun-Hsien Wu ◽  
Shu-Ting Yen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Transfusion ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Major Trauma ◽  
Trauma System ◽  
Trauma Patients ◽  
Feedback Group ◽  
Hospital Transfer

Abstract Background Undertriage of major trauma patients is unavoidable, especially in the trauma system of rural areas. Timely stabilization and transfer of critical trauma patients remains a great challenge for hospitals with limited resources. No definitive measure has been proven to improve the outcomes of patients transferred with major trauma. The current study hypothesized that regular feedback on inter-hospital transfer of patients with major trauma can improve quality of care and clinical outcomes. Method This retrospective cohort study retrieved data of transferred major trauma patients with an injury severity score (ISS) > 15 between January 2010 and December 2018 from the trauma registry databank of a tertiary medical center. Regular monthly feedback on inter-hospital transfers was initiated in 2014. The patients were divided into a without-feedback group and a with-feedback group. Demographic data, management before transfer, and outcomes after transfer were collected and analyzed. Results A total of 178 patients were included: 69 patients in the without-feedback group and 109 in the with-feedback group. The with-feedback group had a higher ISS (25 vs. 27; p = 0.049), more patients requiring massive transfusion (14.49% vs. 29.36%, p = 0.036), and less patients with Glasgow Coma Scale ≤8 (30.43% vs. 23.85%, p <  0.001). After adjusting for confounding factors, the with-feedback group was associated with a higher rate of blood transfusion before transfer (adjusted odds ratio [aOR]: 2.75; 95% confidence interval [CI]: 1.01–7.52; p = 0.049), shorter time span before blood transfusion (− 31.80 ± 15.14; p = 0.038), and marginally decreased mortality risk (aOR: 0.43; 95% CI: 0.17–1.09; p = 0.076). Conclusion This study revealed that regular feedback on inter-hospital transfer improved the quality of blood transfusion.

Chronic Sternal Pain after Cardiac Surgery

2018 ◽  
Author(s):  
Afzaal Iqbal ◽  
Joel Kent
Keyword(s):  
Quality Of Life ◽  
Cardiac Surgery ◽  
Pain Management ◽  
Pain Relief ◽  
Individualized Treatment ◽  
Adequate Pain Relief ◽  
Careful History ◽  
Rule Out

Chronic post-sternotomy pain (PSP) is a well-known complication of cardiac surgery that is associated with increased morbidity. The lack of adequate pain relief can compromise the patients’ rehabilitation trajectory and diminish their quality of life. Various factors have been identified that contribute to the development and maintenance of PSP. Local and systemic pain management modalities have been identified to mitigate this condition. It is important to conduct a careful history and exam in these patients in order to rule out other causes of pain and properly guide the patient’s management. Individualized treatment will ultimately result in the most effective relief.

Immediate Pain Relief in Disaster Conditions

1985 ◽  
Vol 1 (2) ◽  
pp. 166-168
Author(s):  
Wolfgang Dick ◽  
Rudolf Frey ◽  
A. Madjidi
Keyword(s):  
Pain Relief ◽  
Subcutaneous Administration ◽  
Medical Personnel ◽  
Analgesic Drug ◽  
Adequate Pain Relief ◽  
Opiate Drugs ◽  
Effective Pain Relief ◽  
Long Acting ◽  
Effective Analgesia ◽  
The Ideal

Disaster conditions can be characterized as rare, extraordinary and unpredictable events which threaten, injure or kill many people at the same time. The prime examples are earthquakes, floods, traffic or train accidents with hundreds of victims.While emergency pain relief measures in a few injured victims can be managed individually and really effectively, the requirement for effective pain relief under disaster conditions is still a problem which is largely unsolved. The primary goal of immediate pain relief is the elimination of pain and anxiety which, in themselves, additionally threaten the elementary body functions.The ideal analgesic drug for adequate pain relief under disaster conditions: 1) should provide the patient with effective analgesia under severe or moderate pain conditions; 2) should ideally sedate the emergency patient to a certain extent; 3) must be effective within a few minutes after intra-muscular, subcutaneous or intravenous administration; 4) should be sufficiently long-acting to avoid the necessity for re-administration several times; 5) should be applicable by paramedical as well as medical personnel; 6) should not have any depressant side effects on respiration and circulation, particularly under conditions of shock and trauma; and 7) should not require intensive monitoring of the patient. This drug has still to be discovered.The intramuscular or subcutaneous administration of most drugs cannot be considered as methods of immediate effectiveness because most drugs are slowly absorbed, particularly under conditions of shock and trauma. Although the opiate drugs such as morphine, pethidine, and so forth, are obviously effective analgesics, particularly under conditions of severe pain, they cause respiratory and circulation depression, especially if the patient is suffering from hemorrhagic shock, dyspnea and hypoventilation due to thoracic trauma, and so forth.

Palmitoylethanolamide (PEA) in the treatment of neuropathic pain: a case study

2021 ◽  
pp. 026010602110196
Author(s):  
Despina Kamper
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Underlying Mechanism ◽  
Multidisciplinary Teams ◽  
Post Herpetic Neuralgia ◽  
Appropriate Treatment ◽  
Effective Pain Relief ◽  
Somatosensory Nervous System

Background: Neuropathic pain is a condition caused by a lesion or disease of the somatosensory nervous system. It may present as debilitating pain with a sensation of burning and electric-like symptoms and is often difficult to manage effectively. Although pharmacological medications are the first line of treatment, multidisciplinary teams are sometimes required to provide appropriate treatment to improve quality of life and overall wellbeing. Aim: The aim of this study is to present a case of post herpetic neuralgia relieved successfully by the compound palmitoylethanolamide (PEA) – a natural alternative to pharmacological pain relief. Methods: We present the case of a 67 year-old male with ongoing post-herpetic neuralgia, over a 3-year period, as a result of complications from shingles (herpes zoster). Previous studies on the relationship between PEA and neuropathy were reviewed, with an attempt to discuss the possible underlying mechanism of PEA on neuropathic pain. Results: PEA demonstrated effective pain relief within 48 hours at an administered daily dose of 900 mg (10 mg/kg). Conclusions: PEA may offer a valid nutraceutical treatment for practitioners.

Tele-orthopaedics: A systematic mapping study

2020 ◽  
pp. 1357633X2091930 ◽  
Author(s):  
Ali Behmanesh ◽  
Farahnaz Sadoughi ◽  
Farid Najd Mazhar ◽  
Mohammad Taghi Joghataei ◽  
Shahram Yazdani
Keyword(s):  
Developed Countries ◽  
Systematic Mapping Study ◽  
Physician Patient Relationship ◽  
Exclusion Criteria ◽  
Systematic Mapping ◽  
The Usa ◽  
Research Questions ◽  
Physician Patient ◽  
Near Future

Introduction The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services and provide an overview of the trends in the field. Methods In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria. Results We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician–patient relationship was more common than other interactions, such as physician–physician and physician–robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland. Discussion Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future.

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