Classification of pain and methods of pain relief
Any injury with damage to body tissues are almost always accompanied by pain, whichIn turn, cause discomfort victims, and is often caused by the use of painkillers, sometimes irrational.
The pain - a subjective reaction to the injury, and the reaction purely individual and not always correlated with the amount of injuries. One and the same person will react differently to the same traumasubject to various circumstances (for example, under stress, with fatigue reduces the pain threshold).
Therefore, for the preliminary assessment of pain using the so-called 10-point scale of pain, where 0 - is the lack of discomfort, and 10 - the maximum pain (at the turn of the large bones, for example - a fracture of the femurbone or a fracture of the pelvis).
In general anesthesia when we must achieve several objectives. In the first place - to help the injured to such an extent that he could continue to perform combat mission, and secondly: to quickly and efficiently actually numb, thirdly: to avoid or prevent the development of possible side effects.
Complete primary debridement using local anesthetics (without the use of systemic analgesics), cooling with thermal burns, the use of traction tire for fractures of large bones of the extremities, the use of cold for injuries of the joints or softtissue - can greatly ease the pain.
Depending on the injuries and the level of pain is possible to use one of three options for pain relief:
Option 1 . Painful Bluescore of mild to moderate intensity.
This allows the wounded trauma perform combat mission.
It is recommended to take a set of tablets (pill-pack or a pill-box), which includes the paracetamol 1000 mg, 15 mg meloxicam and broad-spectrum antibiotic DII.
Each fighter must be provided with its ownKIT tablets and should be instructed on the Admission of the latter. That is a fighter needs to know that in case of injury with damage to the skin or mucous it should take all the pills at the same time, swallow and drink some water. Read more about the set of pills can be found here.
Also, trauma, accompanied by painsyndrome average intensity may use non-steroidal antiinflammatory drugs in injectable form. It is desirable to have formulations may be administered not only vnutrishnomyazevo but intravenously. These include products based on dexketoprofen (Deksalgin, cavers, Depiofen), ketoprofen (Ketonal (IV administration only under the conditionsBarrier-hospital)), ketorolac tromethamine (Ketanov, Ketorol, Ketalgin). It is desirable to take into account the systemic contraindications to the use of NSAIDs (see instructions in the drug).
Option 2 < / em> . Pain syndrome moderate to severe intensity, while there is no indication in the fighterIn shock, no signs of respiratory distress syndrome (dyspnea) and you do not expect the likely development of these states.
Only under these conditions can be considered the option of using opioid painkillers (analgesics central action).
These include fentanyl, morphine, nalbuphine, butorphanol, promedol, omnopon and dTHER drugs.
When using any drug in this group is necessary to observe a number of reservations, namely:
- before use to make sure that fighters are no contraindications. Apart from the above contraindications (shock, signs of respiratory distress syndrome) Contraindications include injuryhead with signs of head trauma, alcohol consumption and the use of other drugs which enhance the effects of opioids;
- before using to evaluate mental status scale AVPU, and document final;
- to control the state of consciousness and breathing after using painkillers; All the wounded have received opioids or Remamine require careful monitoring of respiratory airway, consciousness and hemodynamic parameters;
- is necessary to ensure venous access, failing to provide venous access for up to 90 seconds - intraosseous access;
- use of opiates is only possible with naloxone. The same was said orderMinistry of Health ¹120 from 25.02.2009;
- use of opiates is permitted in the presence of respiratory equipment (duct type Gvedela or Ivory, facial mask, Ambu bag);
- is allowed to use only those with the skills .chto resuscitation in full.
No special measures (extract from the order on the application ofnalbuphine)
Use nalbuphine as an adjunct to general anesthesia should only specially trained personnel. Must be vigilant security measures with respect to the possible occurrence of respiratory depression, namely: naloxone, equipment for intubation and ventilyatsii light.
After using opiates NECESSARILY it should be noted in the medical record or the victim (in the absence of the card you can use the form ¹100 MO), or in another way (attached in the form of vials used to write on the face of the letter M (from the word « morphine »).
Monitoring: Pulse oximetry should be available as a supplement to clinical monitoring. All persons with moderate and severe head trauma have to be provided saturation control (at least at the level of 90%).
Document the clinical assessment of victim assistance and made changes in the state nostradavshego wounded in the Map (TCCC Casualty Card (DD Form 1380). Talk to the victim, cheering, help and explain their actions.
PROJECTED side effects that can be expected when using opiates: p >
- Changing the psycho-emotional state. Perhaps as the development of a sedative effect, soand excitement. Especially dangerous is the combination of opiates and alcohol. You may experience hallucinations.
- Nausea and vomiting as a result of DII in the vomiting center located in the medulla of the brain department. The decision can be found on the site.
- Respiratory depression as a consequence of DII opiates on the respiratory center.
- The deterioration of hemodynamics, and theyenno drop in blood pressure (not all opioids).
If you have decided to anesthetize, then the drug of choice in accordance with the recommendations Shhh is a fentanyl citrate oral transmucosal form of release (OFTTS) easier - in the form of candy, at a dose of 800 micrograms.
It is imperative SIZEStith lollipop between the cheek and gum, and check that the victim is not chewed or swallowed whole drug that may enter more than necessary doses, because the action and the expected side effects are dose dependent.
Attach candy the finger of the victim or to the uniforms as a means of further withoutdanger.
If you use this drug through the oral mucosa gets into the sublingual venous plexus, from which reaches the systemic circulation quickly. This method of administration alone requires BB / VC in the vascular access but for timely elimination of possible side effects (eg. RVOshe) is required to provide vascular access.
Monitor the condition of the victim, his state of consciousness, the level of pain. Watch for signs of respiratory depression.
In case of failure of the first dose may re-use is not earlier than 15 minutes.
Do not use a double dose if ODNOAH WAS ENOUGH!
In the absence of OFTTS possible to use injectable forms of opiate painkillers. A mandatory requirement is the presence of peripheral venous (or internal bone) access. It allowed only administration of the drug, which allows a quick analgesic effect when usedthe minimum dose of the drug.
Among the infectious agents drug of choice is morphine. The first dose is 5 mg of morphine, and then re-evaluate the condition of the patient and if necessary the dose was repeated every 10 minutes if necessary to achieve analgesia or until the maximum dose of 20 mg.
Justit is important to monitor the state of mind, check for signs of respiratory depression.
nalbuphine also recommended to introduce only intravenously, the first dose of 10 mg followed by overestimate the condition of the victim and, if necessary, repeat administration of 5 mg to achieve the effect of anesthesia or until the maximum dose30 mg.
If you are using butorphanol, if the drug is released in the form of a syringe tube, it is difficult to dose the necessary credits. It is therefore recommended to introduce the content of the syringe tube introduced into 100 ml saline. solution. With a slow IV administration is possible to obtain a sufficient analgesic effect of the minimum effective dose of the drug, avoiding the frontozirovki and development of side effects.