Critical Care Pain Management

Pain Management Protocol

• Pain is the most common complaint; effective control reduces anxiety and discomfort.
• Assess pain using the Pain Assessment Scale (0-10) or Wong-Baker Faces Pain Rating Scale.
• Position the patient for comfort and provide reassurance.
• Consider treatment options like ice or splinting, reassessing pain after interventions.
• Pain management includes pharmaceutical options, with medication guidelines based on systolic blood pressure (>90 mmHg).

Medication Administration Guidelines

• Morphine Sulfate: 2-5 mg IV every 5 minutes; if IV access fails, 2-5 mg IM every 15 minutes.
• Ondansetron (Zofran): 4 mg IV/IM for nausea, repeat in 15 minutes if needed.
• Fentanyl: 50 mcg IV over 2 minutes, repeatable once; 50 mcg IM if IV access fails.
• Hydromorphone: Administer 0.5-1 mg IV, repeat once.
• Ketamine: 30 mg IV for patients over 15, after opioid administration.

Monitoring and Special Considerations

• Monitor for respiratory depression and blood pressure after narcotic administration (check 5 mins post-dose).
• Confirm no allergies to medications before administration; consult Medical Control for patients with head injuries or unstable vital signs.
• In renal failure cases, reduce Fentanyl dose to 25 mcg.

Sedation Management

• Address anxiety and confusion; attempt verbal reassurance first.
• If sedation is necessary, choose appropriate sedative medications:
  • Midazolam: 2.5-5 mg IV/IM, repeatable in 5 minutes.
  • Lorazepam: 1-4 mg IV, repeat every 15 minutes.
  • Diazepam: 2-10 mg IV/IM, repeat every 10 minutes.
  • Propofol: Continuous IV infusion, titrate as needed (5-55 mcg/kg/min).

Restraint and Safety Measures

• Seek restraint orders if patient safety is uncertain during transport.
• Prepare for potential airway support; have bag valve mask ready.
• Ketamine can be given at 1 mg/kg IV or 2 mg/kg IM if necessary.

Accessing and Using Medical Devices

• Maintain aseptic technique when accessing Implanted Subcutaneous Ports or Central Venous Catheters.
• Scrub injection caps with antiseptic, allow to dry before access.
• Use single-use flush systems and flush vigorously to prevent reflux.

Blood Product Administration

• Administer blood products urgently for cases of acute blood loss and clinical instability after 2 liters Normal Saline.
• Evaluate patients for signs of shock such as low BP, tachycardia, and altered mental status.
• Confirm baseline vital signs, review previous transfusion history, and ensure IV site patency before administering blood products.

Pre-Administration Checks

• Verify blood products' temperature (2-8°C) and administration within 4 hours.
• Dual verification of patient details, blood type, and product information by healthcare providers.

Infusion Management and Reaction Protocol

• Start infusions slowly, monitoring closely for adverse reactions; rates can be increased after initial assessment.
• If a reaction occurs, stop transfusion, conduct reassessment, and document all findings and actions taken.
• Use appropriate filters and saline to support transfusion, documenting infusion details thoroughly.

Post-Infusion Care

• Flush IV site with Normal Saline after completion of blood product administration.
• Consider medications like Diphenhydramine for allergic reactions or Furosemide for signs of CHF after transfusion.

Documentation Requirements

• Record blood product details, infusion start and end times, total volume infused, and the patient's response to the treatment.

Explore the essential concepts surrounding pain management in critical care settings through this quiz. Understanding the assessment of pain severity and relief strategies can significantly enhance patient comfort and care. Ideal for healthcare professionals involved in pain management.