Implementation of a multimodal analgesia protocol in a burn patient in the emergency department
1Department of Anaesthesiology, University Hospital of Heraklion, Crete, Greece
2Medical School, University of Crete, Heraklion, Greece
DOI: 10.22514/sv.2021.184 Vol.17,Issue S1,September 2021 pp.39-39
Submitted: 26 August 2021 Accepted: 06 September 2021
Published: 15 September 2021
Introducton: Survival post-severe burn has increased significantly, and prognosis is not limited to survival or functionality, but extends to ensuring a pain-free quality of life. Pain management is one of the most crucial challenges in the care of severely burnt patients and includes pharmacological and non-pharmacological methods.
Methods: Pain management report of a burn patient in the emergency department.
Results: A 37-year-old male patient was admitted to the emergency department with hands, lower extremities, perineum and lower abdomen burns, after an explosion of a tank and leakage of steam and chemicals. The burn injury of partial thickness occupied about 25% of the total body surface. During the initial ABCDE assessment no life-threatening condition was found and attention was focused on pain management (reported VAS score 10). Wet gauges were applied to the burn area and paracetamol 1 gr, morphine 10 mg (in increments), pethidine 100mg, ketamine 60 mg, dexamethasone 8 mg, parecoxib 40 mg and midazolam 3 mg were administered intravenously, without significant improvement. A PCA pump with simultaneous continuous infusion and on-demand boluses of a solution of morphine, ketamine, lidocaine and midazolam was used, resulting in pain improvement (VAS score 5/10). Analgesia with PCA and systemic administration of paracetamol was continued in ward, where the patient stayed for 24 hours steadily improving (VAS score 4/10). On the 2nd day decision was made to transfer the patient to a specialised burn centre.
Conclusions: Burn pain is complex and unpredictable, with features of nociceptive, psychogenic and neuropathic pain, including a strong element of hyperalgesia. Unfortunately, despite recognizing the importance of analgesia in the management of burns, such patients are often undertreated in the emergency department. Continuous pain reassessment and recording and the application of individualized multimodal analgesia protocols are required, with emphasis placed on the use of PCA pumps in a monitored care unit.
Vasileia Nyktari,George Papastratigakis,Periklis Vasilos,Georgios Stefanakis,Eleni Diamantaki,Emmanouela Koutoulaki,Nikolaos Tserlikakis,Alexandra Papaioannou. Implementation of a multimodal analgesia protocol in a burn patient in the emergency department. Signa Vitae. 2021. 17(S1);39-39.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.