Trauma analgesia

Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, et al. Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia a randomized controlled trial. Ann Emerg Med June 2012 59(6) 497-503. 

General Information Use of Ketamine for Out-of-Hospital Trauma Analgesia... 

Most of the time, the powerful analgesia suppHed by morphine and the other opioid analgesics is not needed. Rather, a mild analgesic, such as aspirin, the most commonly employed analgesic agent, can be used for the treatment of simple pain associated with headaches, minor muscle pain, mild trauma, arthritis, cold and flu symptoms, and fever. 

Pain Action Unknown but may stimulate opioid sites, sedation and analgesia Dose Adults. Self administered inhalation (generally 25-50% w/ oxygen) until pain relief or pt drops mask/falls asleep Peds. Same as adult (onset w/in 2-5 min) Caution [ , ] Do not use after full meal Contra EtOH intox AMS following head injury COPD, thoracic trauma Disp Supplied in blue cylinders SE N/V, Light-headedness, AMS and hallucinations Interactions T CNS depression Wf opiates, EtOH, sedatives EMS Do not strap mask to pt s face, allow pt to hold the mask to their face dosing is self-limiting when pt drops mask d/t CNS depression typically used for bums and fractures... 

Naloxone will block the effects of opiate drugs and is used to treat overdoses. It was found that during trauma the use of naloxone would increase pain and prevent naturally induced analgesia. It was only a matter of time until the endogenous opiates, the endorphins (for endogenous morphine) and enkephalins, were discovered. Now there exists a whole nomenclature of opiate receptor types and their various effects. 

Mohna PE. Endogenous opioid analgesia in hemorrhagic shock. J Trauma. 2003 54(suppl 5) S126-S132. 

Fulda, G. J., Giberson, F., and Fagraeus, L. (2005), A prospective randomized trial of nebulized morphine compared with patient-controlled analgesia morphine in the management of acute thoracic pain, J. Trauma, 59, 383-388 discussion 389-390. 

It is an important factor in paediatric trauma radiography that good analgesia is provided for... 

Susceptibility factors Age Fentanyl 2 micrograms/kg in children aged 3-18 years for analgesia following orthopedic trauma was effective within 10 minutes of administration and was not associated with adverse events [91 ]. 

Following subcutaneous or IM administration, onset of analgesia occurs within 10-15 minutes and peak effects occur within 1 hour [1,3]. Meperidine binds to both albumen and alpha-l-acid glycoprotein (AAG). The AAG level is dependent on the stress response and levels increase with trauma and infection. Further variability may be induced by eryrthocyte binding. Following intramuscular administration of meperidine the elimination half-life is 3.6 hours (3.1-4.1 hours). The average parenteral dose of meperidine is 1-1.5 mg/kg. 

Identification identify factors such as total opidd dose requirement, previous surgery/trauma resulting in undermedication, inadequate analgesia or relapse episodes... 

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