Buradasınız

Acil koşullarda ağrı yönetimi ve analjezi uygulamaları

Management of pain and practice of analgesia in the emergency setting

Journal Name:

Publication Year:

DOI: 
doi:10.2399/tahd.10.053

Keywords (Original Language):

Author NameFaculty of Author
Abstract (2. Language): 
Pain constitutes the vast majority of all referrals in the emergency setting per se. The present review is designed to discuss and enlighten the practice of analgesia, based on literature findings and our experiences. Pain is often viewed as an ill-defined, elusive and subjective condition to describe and interpret. It is also a behavioral pattern strongly affected by expectations and experiences. Pain is defined as a sensory and emotional experience deriving from any part of the body, in response to tissue injury or a related process. Nonetheless, the pathophysiology of acute pain is more clear-cut, easy to diagnose, and efficiently treated. However, many studies demonstrate that healthcare workers do not respond sensitively enough facing acute (emergency) or chronic pain. It is reported in many instances that waiting times for analgesia are unnecessarily longer than reasonable and most patients are treated with inade¬quate dosages (oligoanalgesia). The presence and severity of pain should be distinctly questioned by physicians and nurses, instead of trying to make estimations about it. There is no better instrument than the patients' self report to gauge the pain. The priority is to relieve the pain in the emergency management of pain in the emer¬gency setting. The management of pain should be instituted in the very beginning of the patients' admission and should include expe¬dient and proper treatment with right choice of analgesics.
Abstract (Original Language): 
Ağrı tüm sağlık sisteminde en sık acil başvuru nedenidir. Makalemizde literatür bilgilerinden ve deneyimlerimizden hareketle acil koşullarda önerilen analjezi uygulama pratiği tartışılmaktadır. Ağrı sübjektif, güç ve sıklıkla tanımlanması ve yorumlanması zor bir durumdur. Beklentiler ve deneyimlerden etkilenen bir davranış bi¬çimidir. Ağrı vücudun herhangi bir yerinden kaynaklanan, doku hasarına veya potansiyel doku hasarı ile birlikte olan ya da böyle bir hasar sürecinde tanımlanan duyusal ve emosyonel deneyim olarak tanımlanmıştır. Akut ağrı patofizyolojisi oldukça iyi anlaşılmıştır, tanısı zor değildir ve tedavi etkindir. Buna karşın birçok araştırmada hekim ve hemşirelerin hem acil durumlarda veya akut ağrıda, hem de kronik ağrı karşısında yeterince duyarlı davranmadıkları bildirilmiştir. Acil servislerde sıklıkla analjezi için bekletilme sürelerinin gereksiz uzadığı ve yetersiz dozda analjezik uygulandı¬ğı gösterilmiştir (oligoanaljezi). Acil hekim ve hemşireleri ağrının olup olmadığını tahmin etmeye çalışmak yerine mutlaka hastaya sormalıdırlar. Hastanın kendi ifadesi ağrı için en güvenilir göster¬gedir. Acil serviste ağrı yönetiminde ilk öncelik ağrıyı geçirmek ol¬malıdır. Ağrı yönetimi hastanın girişinde başlamalı ve uygun za¬manda doğru analjezik ilacın uygulanmasını içermelidir.
53-63

REFERENCES

References: 

1. Wheeler E, Hardie T, Klemm P ve ark. Level of pain and waiting time in the emergency department. Pain Manag Nurs 2010; 11: 108-14.
2. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004-17.
3. Malviya S, Naughton NN, Tremper KK. Sedation and Analgesia for Diagnostic and Therapeutic Procedures. New Jersey, Humana Press,
2003; 62-92
4. Berthier F, Pottel G, Leconte P. Comparative study of methods of meas¬uring acute pain intensity in an ED. Am J Emerg Med 1998; 16: 132-6.
5. Comprehensive accreditation Manual for Hospitals, Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Update 3, 1999. URL: http://www.jcrinc.com/Joint-Commission-Requirements/Hospitals/#PC adresinden 10.05.2010 tarihinde erişilmiştir.
Türkiye Aile Hekimliği Dergisi |
Turkish Journal of Family Practice | Cilt 14 | Sayı 2 | 2010
61
6.
Erdin
e S. Ağrı nörofizyolojisi. Hipokrat Dergisi 1996; 9-12.
7. Raj PP.
Ağrı taksonomisi. Ağrı'da. Ed. Erdine S. 2. Baskı. Istanbul, Nobel
Tıp
Kitapevleri
, 2000; 12-9.
8. Erlanger J, Gasser HS. Electrical Signs of Nervous Activity. Philadelphia, University of Pennsylvania Press, 1937.
9. Coda BA, Bonica JJ. General Considerations of Acute Pain. Bonica's Management of Pain'de. Ed. Loeser JD, Butler SH, Chapman CR, Turk DC. 3.baskı. Philadelphia, Lea and Febiger. 2001; 222-40.
10. Derasari MD. Taxonomy of Pain Syndromes: Classification of Chronic Pain Syndromes. Practical Management of Pain'de. Ed. Raj PP, Abrams
BM, Benson HT, Hahn MB. 3. Baskı. Missouri, Mosby Year Book, 2000; 10-6.
11. Turk CD, Okifuji A. Pain Terms and Taxonomies of Pain. Bonica's Management of Pain'de. Ed. Loeser JD, Butler SH, Chapman CR, Turk
CD. 3. Baskı. Philadelphia, Lea and Febiger, 2001; 17-25.
12. Carr DB, Gardas CL. Acute pain. Lancet 1999; 353: 2051-8.
13. Ho K, Spence J, Murphy MF. Review of pain-measurement tools. Ann
Emerg Med 1996; 27: 427-32.
14. Tintinalli J. Emergency Medicine: A Comprehensive Study Guide. New
York, USA, McGraw Hill Book Co, 2004; 257-86.
15. Chudnofsky CR, Lozon MM. Sedation and analgesia for procedures. Rosen's Emergency Medicine: Concepts and Clinical Practice'de. Ed. Marx JA, Hockberger RS, Walls RM. 5. Baskı. St. Louis, Mosby, Inc. 2002; 2578-90.
16. Ducharme J. Emergency pain management: A Canadian Association of Emergency Physicians (CAEP) Consensus Document. J Emerg Med 1994;
12: 855.
17. Murray MJ. Pain problems in the ICU. Crit Care Clin 1990; 6: 235-53.
18. Ossewaarde SB. Pain management practice in the acute adult trauma patient. A thesis, submitted to Grand Valley State University. UMI Co,
1997; 1-33.
19. Raftery KA, Smith-Coggins R, Chen AHM. Gender-associated differ¬ences in emergency department pain management. Ann Emerg Med 1995;
26: 414-21.
20. Jones JS, Johnson K, McNinch M. Age as a risk factor for inadequate emergency department analgesia. Am J Emerg Med 1996; 14: 157-60.
21. Acute Pain Management Guideline Panel. Acute Pain Management: Operative or Medical Procedures and Trauma: Clinical Practice Guideline. Washington DC, US Department of Health and Human Services, 1992.
22. Singer AJ, Kowalska A. Ability of patients to accurately recall the severi¬ty of acute painful events. Acad Emerg Med 2001; 8: 292-5.
23. Liebelt E, Levick N. Acute pain management, analgesia, and anxiolysis in the adult patient. Emergency Medicine, A Comprehensive Study Guide'da. Ed. Tintinalli J, Kelen GD, Stapczynski JS. 5. Baskı. New
York, McGraw-Hill, 2000; 251-6.
24. Jacques S Lee: Pain measurement: Understanding existing tools and their application in the emergency department. Emerg Med 2001; 13: 279-87.
25. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain. Clinical significance in postoperative patients. Anesthesiology 2001; 95: 1356-61.
26. Barsan WG, Tomassoni AJ, Seger D ve ark. Safety of high dose analgesia for emergency department procedures. Ann Emerg Med 1993; 22: 155.
27. Clark RF, Wei EM, Anderson PO. Meperidine: Therapeutic use and tox-
icity. J Emerg Med1995; 13: 797.
28. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department.
Am J Emerg Med1989; 7: 620-3.
29. Karcioglu O, Topacoglu H, Ozucelık DN, Yuruktumen A, Ergun N. Oligoanalgesia: the challenge in the emergency department. Middle East J
Emerg Med 2005; 5: 3-7.
30. Mace SE, Barata IA, Cravero JP ve ark. EMSC Grant Panel (Writing
Committee) on Pharmacologic Agents Used in Pediatric Sedation and Analgesia in the Emergency Department; American Academy of Pediatrics; American Pediatric Surgical Association; Emergency Nurses Association. Clinical policy: evidence-based approach to pharmacologic agents used in pediatric sedation and analgesia in the emergency depart¬ment. J Pediatr Surg2004; 39: 1472-84.
31. Galinski M, Ruscev M, Gonzalez G ve ark. Prevalence and management of acute pain in prehospital emergency medicine. Prehosp Emerg Care
2010; 14: 334-9.
32. Ricard-Hibon A, Chollet C, Sagda S ve ark. A quality control program for acute pain management in out-of hospital care medicine. Ann Emerg Med
1999; 34: 738-44.
33. Lovecchio F, Oster N, Sturmann K ve ark. The use of analgesics in patients with acute abdominal pain. J Emerg Med1997; 15: 775-9.
34. Pace S, Burke TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med1996; 3: 1086-92.
35. Grundmann RT, Petersen M, Lippert H, Meyer F. The acute (surgical) abdomen - epidemiology, diagnosis and general principles of manage¬ment. Z Gastroenterol 2010; 48: 696-706.
36. Banz VM, Christen B, Paul K ve ark. Gender, age and ethnic aspects of analgesia in acute abdominal pain: is analgesia even across the groups?
Intern Med J2010; 11. doi:10.1111/j.1445-5994.2010.02255.x
37. Rehmani RS. Pain practices in a Saudi emergency department. Saudi Med
J2010; 31: 539-44.
38. Erstad BL, Shilpa C, Esser MJ. Prescribing of analgesics in trauma patients. Am J Therapeutics1997; 4: 27-30.
39. Goodacre SW, Roden RK. A protocol to improve analgesic use in the accident and emergency department. J Accid Emerg Med1996; 13: 177-9.
40. Sullivan LM. Factors influencing pain management: a nursing perspec¬tive. J Post Anesth Nurs1994; 2: 83-90.
41. Lewis LM, Lasater LC, Brooks CB. Are emergency physicians too stingy with anajgesics? South Med J 1994; 87: 7-9.
42. Friedland LR, Kulick RM. Emergency department analgesic use in pedi-atric trauma victims with fractures. Ann Emerg Med 1994; 23: 203-7.
43. Lazio MP, Costello HH, Courtney DM ve ark. A comparison of analgesic management for emergency department patients with sickle cell disease
and renal colic. Clin J Pain 2010; 26: 199-205.
44. Emerman DL. Pain management in the emergency department. Emerg
Med Reports2002; 23: 53-68.
45. Paris PM, Stewart R. Pain management. Emergency Medicine: Concepts and Clinical Practice'de. Ed. Rosen P, Barkin R ve ark. 4. baskı. St Louis,
Mosby, 1997; 276-300.
S
>5
LU O H
62
Karcıoğlu Ö | Acil koşullarda ağrı yönetimi ve analjezi uygulamaları
46. Ford M. The management of moderate to severe pain with parenteral analgesics. Pain: Management of Pain in the Emergency Department'da.
Ed. Goldfrank L. Princeton, Excerpta Medica, 1990; 29-37.
47. Hall LG, Oyen LJ, Murray MJ. Analgesic agents. Pharmacology and application in critical care. Crit Care Clin 2001; 17: 899-923.
48. Blackburn P, Vissers R. Pharmacology of emergency department pain management and conscious sedation. Emerg Med Clin North Am 2000; 18:
803-7.
49. Rodgers PE. Analgesic medications. Clin Fam Prac 2000; 2: 509-31.
50. Bukata WR. USPHS Clinical practice guidelines for acute pain manage¬ment. Emerg Med Acute Care Essays1993; 17: 1-4.
51. Volles DF, McGory R. Perspectives in pain management: pharmacoki-netic considerations. Crit Care Clinics1999; 15: 55-75.
52. Shapiro BA, Warren J, Egol AB ve ark. Practice parameters for intra¬venous analgesia and sedation for adult patients in the intensive care unit: An executive summary. Crit Care Med1995; 23: 1596-600.
53. Selbst SM, Clark M. Analgesic use in the emergency department. Ann
Emerg Med 1990; 19: 1010-3.
54. Whipple JK, Lewis KS, Quebbeman EJ ve ark. Analysis of pain manage¬ment in critically ill patients. Pharmacotherapy1995; 15: 592-9.
55. Way WL, Fields HL, Way EL. Opioid analgesics and antagonists. Basic Clinical pharmacology1997; 23: 521-54.
56. Topacoglu H, Karcioglu O, Cimrin O, Arnold J. Respiratory arrest after
low-dose fentanyl. Ann Saudi Med2005; 25: 508-10.
57. Summers S. Evidence-based practice. Part 2: reliability and validity of selected acute pain instrument. J Peri Anesthesia Nurs2001; 16: 35-40.

Thank you for copying data from http://www.arastirmax.com