Abstract
Traumatic injuries occur very frequently and are almost universally painful. The current thesis describes current practices and evaluates several strategies to improve pain management in adult patients presenting to the Emergency Department with acute traumatic injuries. More specifically, several aspects of pain management in triage including health care provider-related and patient-related factors are described. In addition, several specific pharmacological analgesic strategies in common Emergency Department presentations will be evaluated. The most important findings of this thesis are:
- In order to improve pain treatment, a nurse-driven pain treatment protocol in which nursing staff can administer analgesia autonomously should be in place. However, implementation alone is not enough; education, frequent auditing and reassessments of pain severity are necessary as well.
- The most common beliefs among patients who decline analgesics are that these should be used only in extreme pain, fear of addiction and the belief that pain medication could decrease the physician’s ability to appropriately judge the injury. These beliefs should be actively addressed in case patients refuse pain medication.
- Both a multicenter randomized controlled trial and a systematic review showed that adult patients with acute minor musculoskeletal injuries, such as strains and sprains, should be treated with paracetamol, since NSAIDs do not have significant additional analgesic value.
- Lidocaine soaked gauzes without vasoconstrictive additives cannot replace infiltration anesthesia in acute wounds.
- The supra-inguinal technique of performing a Fascia Iliaca Compartment Block is effective in elderly patients with hip fractures, according to a case series.
- In order to improve pain treatment, a nurse-driven pain treatment protocol in which nursing staff can administer analgesia autonomously should be in place. However, implementation alone is not enough; education, frequent auditing and reassessments of pain severity are necessary as well.
- The most common beliefs among patients who decline analgesics are that these should be used only in extreme pain, fear of addiction and the belief that pain medication could decrease the physician’s ability to appropriately judge the injury. These beliefs should be actively addressed in case patients refuse pain medication.
- Both a multicenter randomized controlled trial and a systematic review showed that adult patients with acute minor musculoskeletal injuries, such as strains and sprains, should be treated with paracetamol, since NSAIDs do not have significant additional analgesic value.
- Lidocaine soaked gauzes without vasoconstrictive additives cannot replace infiltration anesthesia in acute wounds.
- The supra-inguinal technique of performing a Fascia Iliaca Compartment Block is effective in elderly patients with hip fractures, according to a case series.
| Original language | English |
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| Qualification | Doctor of Philosophy |
| Awarding Institution | |
| Supervisors/Advisors |
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| Award date | 8 Mar 2019 |
| Print ISBNs | 9789463752824 |
| Publication status | Published - 2019 |
