The use of Penthrox (methoxyflurane) in trauma patients

2019 ◽  
Vol 1 (9) ◽  
pp. 454-457
Author(s):  
Manuel Sevillano-Barbero ◽  
Claire Ruddy
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Half Life ◽  
Severe Pain ◽  
Hospital Setting ◽  
Trauma Patients ◽  
Emergency Relief ◽  
Non Invasive ◽  
Continuous Use ◽  
The Ideal

Penthrox (methoxyflurane) is an inhaled analgesic. It is a non-invasive, lightweight, portable handheld inhaler indicated for the emergency relief of moderate-to-severe pain in conscious adult patients with trauma. It is becoming very popular in the pre-hospital setting and in the emergency department and has been proven to reduce acute pain within 6–10 inhalations. One 3 ml bottle will provide effective analgesic relief for up to 30 minutes (continuous use) or 1 hour (intermittent use). With very few drug interactions and a short half-life, it is the ideal analgesic for conscious patients. However, it is not recommended to use regularly and should not replace a good analgesic approach.

scholarly journals Cost of Intravenous Analgesia for the Management of Acute Pain in the Emergency Department is Substantial in the United States

10.36469/9793 ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Pamela P. Palmer ◽  
Judith A. Walker ◽  
Asad E. Patanwala ◽  
Carin A. Hagberg ◽  
John A. House
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Severe Pain ◽  
The United States ◽  
Rapid Onset ◽  
Opioid Use ◽  
Nursing Time ◽  
Opioid Administration ◽  
Intravenous Analgesia ◽  
Set Up

Background: Pain is a leading cause of admission to the emergency department (ED) and moderate-to-severe acute pain in medically supervised settings is often treated with intravenous (IV) opioids. With novel noninvasive analgesic products in development for this indication, it is important to assess the costs associated with IV administration of opioids. Materials and Methods: A retrospective observational study of data derived from the Premier database was conducted. All ED encounters of adult patients treated with IV opioids during a 2-year time period, who were charged for at least one IV opioid administration in the ED were included. Hospital reported costs were used to estimate the costs to administer IV opioids. Results: Over a 24 month-period, 7.3 million encounters, which included the administration of IV opioids took place in 614 US EDs. The mean cost per encounter of IV administration of an initial dose of the three most frequently prescribed opioids were: morphine $145, hydromorphone $146, and fentanyl $147. The main driver of the total costs is the cost of nursing time and equipment cost to set up and maintain an IV infusion ($140 ± 60). Adding a second dose of opioid, brings the average costs to $151-$154. If costs associated with the management of opioid-related adverse events and IV-related complications are also added, the total costs can amount to $269-$273. Of these 7.3 million encounters, 4.3 million (58%) did not lead to hospital admission of the patient and, therefore, the patient may have only required an IV catheter for opioid administration. Conclusions: IV opioid use in the ED is indicated for moderate-to-severe pain but is associated with significant costs. In subjects who are discharged from the ED and may not have required an IV for reasons other than opioid administration, rapid-onset analgesics for moderate-to-severe pain that do not require IV administration could lead to direct cost reductions and improved care.

scholarly journals P029: Are acute pain trajectories after an emergency department visit associated with chronic pain at 3 months?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S73
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
A. Cournoyer ◽  
E. Piette ◽  
J. Morris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Pain Intensity ◽  
Acute Pain ◽  
Severe Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Intensity Level ◽  
Opioid Prescription ◽  
Pain Condition

Introduction: Studies suggest that acute pain evolution after an emergency department (ED) visit has been associated with the development of chronic pain. Using group-based trajectory modeling (GBTM), we aimed to evaluate if ED discharged patients with similar pain intensity profiles of change over 14 days are associated with chronic pain at 3 months. Methods: This is a prospective cohort study of patients aged 18 years or older who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity level (0-10 numeric rating scale). Three months post-ED visit, participants were interviewed by phone to report their pain intensity related to the initial pain. Results: A total of 305 patients were retained at 3 months (mean age ± SD: 55 ± 15 years, 49% women). Using GBTM, six distinct pain intensity trajectories were identified during the first 14 days of the acute pain period; two linear one with moderate or severe pain during the follow-up (representing almost 40% of the patients) and four cubic polynomial order trajectories, with mild or no-pain at the end of the 14 days (low final pain). Twelve percent (11.9; ±95%CI: 8.2-15.4) of the patients had chronic pain at 3 months. Controlling for age, sex and types of pain condition, patients with trajectories of moderate or severe pain and those with only severe pain were 5.1 (95%CI: 2.2-11.8) and 8.2 (95%CI: 3.4-20.0) times more likely to develop chronic pain at 3 months, respectively, compared to the low final pain group. Conclusion: Trajectories could be useful to early identification of patients at risk of chronic pain.

scholarly journals Efektifitas Ketepatan Triage Trauma Terhadap Aktivasi Kode Trauma Pada Pasien Trauma Kategori Merah Di Instalasi Gawat Darurat: Literature Review

JKEP ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 29-42
Author(s):  
Fatriani Fatriani ◽  
Masfuri Masfuri ◽  
Agung Waluyo
Keyword(s):  
Emergency Department ◽  
Health Workers ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Patients ◽  
Emergency Relief ◽  
Initial Management ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Management Priorities

Emergency trauma can occur at any time, occur everywhere and can be experienced by everyone. The speed and accuracy of relief in trauma emergency conditions, will determine the outcome of the assistance provided. Help for trauma patients in the Emergency Department begins when the triage officer receives the patient. The triage process sorts patients according to the patient's emergency condition using parameters of level of consciousness, respiratory status and circulation status of the patient. An efficient trauma triage system aims to assist health workers in identifying life-threatening conditions, making timely assessments and management priorities that are appropriate to the severity of the patient. Trauma Code Activation is implemented as a system for providing emergency relief in cases of trauma in the red category. In some countries the application of Trauma Team Activation in cases of trauma in the red category is the main one to optimize the initial management of trauma emergency department. Trauma Code Activation at Cipto Mangunkusumo Hospital Jakarta Emergency Department from September 2018 to June 2019 totaled 362 cases, consisting of 34.1% head injuries (7.6% bleeding), 19.3% fractures, 13% burns, 6, 7% politrauma, and there are 3.8% died.

scholarly journals Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul Owono Etoundi ◽  
Junette Arlette Metogo Mbengono ◽  
Ferdinand Ndom Ntock ◽  
Joel Noutakdie Tochie ◽  
Dominique Christelle Anaba Ndom ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Pain Management ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Knowledge Attitudes And Practices

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

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