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Individualized Care Plans for Acute Sickle Cell Pain Crises Individualized Care Plans for Acute Sickle Cell Pain Crises | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search If you would like to view the videos from this event, please click the links below. Vignette Mr. J. is a 22 year old male presenting to your urban emergency department (...) for sickle cell pain crises. In the ED, his vital signs are BP 120/70, P 58, RR 18, T 37.0°C, and 100% oxygen saturation on room air. No objective evidence of acute intoxication or trauma are appreciated. He appears extremely uncomfortable and you note that he has been waiting in triage for 6-hours due to ED crowding. Yesterday, you received separate emails from the American College of Emergency Physician’s and the American Medical Association highlighting the role of physician prescribing in the ongoing
Comparison of Intraoperative Sedation With Dexmedetomidine Versus Propofol on Acute Postoperative Pain in Total Knee Arthroplasty Under Spinal Anesthesia: A Randomized Trial In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol.Forty (...) observer's assessment of alertness/sedation score of 3 or 4. The cumulative amounts of fentanyl administered via intravenous patient-controlled analgesia were recorded at 24 and 48 hours postoperatively (primary outcome). The postoperative numerical rating scale for pain was assessed at 6, 12, 24, and 48 hours (secondary outcome). The postoperative use of additional rescue analgesic (ketoprofen) and antiemetic drugs was also compared between the 2 groups at 24 and 48 hours.Dexmedetomidine significantly
Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department-based Randomized Study Patients with low back pain (LBP) are often treated with nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are modestly effective for LBP, but many patients with LBP continue to suffer despite treatment with these medications. We compared pain and functional outcomes 1 week after emergency department (ED) discharge among patients randomized to a 1-week course (...) of ibuprofen plus acetaminophen versus ibuprofen plus placebo.This was a randomized, double-blind study conducted in two urban EDs. Patients presenting with acute, nontraumatic, nonradicular LBP of no more than 2 weeks' duration were eligible for enrollment immediately prior to discharge from an ED if they had a score > 5 on the Roland Morris Disability Questionnaire (RMDQ), a 24-item validated instrument, indicating more than minimal functional impairment. All patients were given a standardized 10-minute
Diamorphine hydrochloride (Ayendi) - acute severe nociceptive pain in children and adolescents Final Appraisal Recommendation Advice No: 1719 – November 2019 Diamorphine hydrochloride (Ayendi ® ) 720 microgram/actuation and 1600 microgram/actuation Nasal Spray Limited submission by Wockhardt UK Ltd In reaching the above recommendation AWMSG has taken account of the appraisal documentation prepared by the AWMSG Secretariat (reference number 2406), which includes the AWMSG Secretariat Assessment (...) Report (ASAR), the Preliminary Appraisal Recommendation (PAR) and the applicant company’s response to the PAR, clinical expert opinion (where available), the views of patients/patient carers (where available) and the lay member perspective. This recommendation has been ratified by Welsh Government and will be considered for review every three years. Recommendation of AWMSG Diamorphine hydrochloride (Ayendi ® ) is recommended as an option for use within NHS Wales for the treatment of acute severe
Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Management Briefs eBrief-no160 -- Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs eBrief-no160 -- Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Health Services Research & Development Management eBrief (...) no. 160 » Issue 160 October 2019 The report is a product of the VA/HSR&D Evidence Synthesis Program. Evidence Brief: Managing AcutePain in Patients Taking Medications for Opioid Use Disorder Acutepain management in patients with opioid use disorder (OUD) can be challenging due to several factors including increased pain sensitivity and higher opioid tolerance. Use of medications for OUD (MOUD) including methadone, buprenorphine/naloxone, or naltrexone adds to the complexity of acutepain management
Treatment for AcutePain: An Evidence Map Treatment for AcutePain: An Evidence Map Technical Brief Number 33 RTechnical Brief Number 33 Treatment for AcutePain: An Evidence Map Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-0000-81 Prepared by: Minnesota Evidence-based Practice Center Minneapolis, MN Investigators: Michelle Brasure, Ph.D., M.S.P.H., M.L.I.S. Victoria (...) A. Nelson, M.Sc. Shellina Scheiner, PharmD, B.C.G.P. Mary L. Forte, Ph.D., D.C. Mary Butler, Ph.D., M.B.A. Sanket Nagarkar, D.D.S., M.P.H. Jayati Saha, Ph.D. Timothy J. Wilt, M.D., M.P.H. AHRQ Publication No. 19(20)-EHC022-EF Oct ober 2019 ii Key Messages Purpose of review The purpose of this evidence map is to provide a high-level overview of the current guidelines and systematic reviews on pharmacologic and nonpharmacologic treatments for acutepain. We map the evidence for several acutepain
Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines | CADTH.ca Find the information you need Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines (...) Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines Last updated: May 7, 2019 Project Number: RC1109-000 Product Line: Research Type: Devices and Systems Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical effectiveness of multidisciplinary treatment programs for patients with acute or subacute pain in outpatient settings? What is the cost-effectiveness
Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness | CADTH.ca Find the information you need Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness Multidisciplinary Pain Consult Teams for Acute Care in Hospitals: Clinical Utility and Cost-Effectiveness Last updated: August 16, 2019 (...) Project Number: RB1357-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What is the clinical utility of acutepain assessment by multidisciplinary pain consult teams in an inpatient setting? What is the cost-effectiveness of acutepain assessment by multidisciplinary pain consult teams in an inpatient setting? Key Message No relevant health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, non
Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines Smaller Quantity Opioid Prescribing for AcutePain: Clinical Effectiveness and Guidelines Last updated: June 14, 2019 Project Number: RA1039-000 Product Line: Research Type: Drug Report (...) Type: Reference List Result type: Report Question What is the clinical effectiveness of prescribing opioids in smaller quantities for patients with acutepain? What are the evidence-based guidelines associated with opioid prescribing for patients with acutepain? Key Message One systematic review of guidelines, two non-randomized studies, and four evidence-based guidelines were identified regarding smaller quantity opioid prescribing for acutepain. Files Rapid Response Reference List Published
Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating AcutePain in the Emergency Department: A Randomized Controlled Trial Nonsteroidal anti-inflammatory drugs (NSAIDs) are used extensively for the management of acutepain, with ibuprofen being one of the most frequently used oral analgesics in the emergency department (ED). We compare the analgesic efficacy of oral ibuprofen at 3 different doses for adult ED patients with acute pain.This was a randomized, double-blind trial (...) comparing analgesic efficacy of 3 doses of oral ibuprofen (400, 600, and 800 mg) in adult ED patients with acutepainful conditions. Primary outcome included difference in pain scores between the 3 groups at 60 minutes.We enrolled 225 subjects (75 per group). The difference in mean pain scores at 60 minutes between the 400- and 600-mg groups was -0.14 (95% confidence interval [CI] -0.67 to 0.39); between the 400- and 800-mg groups, 0.14 (95% CI -0.65 to 0.37); and between the 600- and 800-mg groups
Chest Pain – Possible Acute Coronary Syndrome American College of Radiology End User License Agreement ACR Appropriateness Criteria is a registered trademark of the American College of Radiology. By accessing the ACR Appropriateness Criteria®, you expressly agree and consent to the terms and conditions as described at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/TermsandConditions.pdf Personal use of material is permitted for research, scientific and/or information purposes only. You (...) Criteria ® Clinical Condition: Chest Pain Suggestive of Acute Coronary Syndrome Radiologic Procedure Rating Comments RRL* Tc-99m SPECT MPI rest and stress 8 This procedure is appropriate for intermediate-to-high likelihood for coronary artery disease. There is abundant literature available on clinical utility. ???? Arteriography coronary 8 This procedure is the gold standard and is invasive. ??? Tc-99m SPECT MPI rest only 7 In the setting of ongoing chest pain, this procedure has a high negative
Comparative Effectiveness of Analgesics To Reduce AcutePain in the Prehospital Setting Comparative Effectiveness of Analgesics To Reduce AcutePain in the Prehospital Setting Comparative Effectiveness Review Number 220 R Comparative Effectiveness Review Number 220 Comparative Effectiveness of Analgesics To Reduce AcutePain in the Prehospital Setting Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 (...) analgesics as treatment of moderate to severe acutepain in the prehospital setting. Key Messages • As initial therapy in the prehospital setting: o Nonsteroidal anti-inflammatory drugs provide similar pain relief to opioids and may cause fewer overall side effects and less drowsiness. o Acetaminophen may provide similar pain relief to opioids, and may cause fewer side effects overall and less dizziness. o Ketamine may provide similar pain relief to opioids. Ketamine may cause more dizziness or overall
Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first-pass metabolism. We aimed to determine whether IN sufentanil (...) (INS) for patients presenting to an emergency department with acute severe traumatic pain results in a reduction in pain intensity non-inferior to IVM.In a prospective, randomized, multicenter non-inferiority trial conducted in the emergency departments of 6 hospitals across France, patients were randomized 1:1 to INS titration (0.3 μg/kg and additional doses of 0.15 μg/kg at 10 minutes and 20 minutes if numerical pain rating scale [NRS] > 3) and intravenous placebo, or to IVM (0.1 mg/kg
Evidence Brief - Managing AcutePain in Patients with Opioid Use Disorder on Medication-assisted Treatment Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Evidence Brief: Managing AcutePain in Patients with Opioid Use Disorder on Medication-assisted Treatment Health Services Research & Development Evidence Brief: Managing AcutePain in Patients with Opioid Use Disorder on Medication-assisted (...) Treatment to the ESP Report RSS feed Prepared by: Evidence Synthesis Program (ESP) Coordinating Center Portland VA Health Care System Portland, OR Mark Helfand, MD, MPH, MS, Director Recommended Citation: Veazie S, Mackey K, Bourne D, Peterson K. Evidence Brief: Managing AcutePain in Patients with Opioid Use Disorder on Medication-Assisted Treatment. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans
Efficacy and safety of loxoprofen sodium topical patch for the treatment of pain in patients with minor acute traumatic limb injuries in Brazil: a randomized, double-blind, noninferiority trial Posttraumatic injury pain is commonly treated with oral nonsteroidal anti-inflammatory drugs. However, oral nonsteroidal anti-inflammatory drugs cause several adverse events, with topical formulations arising as an important alternative. Therefore, we aimed at evaluating the efficacy and safety (...) of loxoprofen patch (LX-P) in the treatment of patients with posttraumatic pain. This phase III, randomized, double-blind, noninferiority study enrolled Brazilian patients aged 18 to 65 years diagnosed with lower and upper limb posttraumatic injury who were experiencing moderate or severe pain. Patients were assigned to active LX-P or to loxoprofen tablet (LX-T), and pain intensity was measured based on a visual analog scale score variation after 7 days of treatment. Data on clinical symptoms, rescue
Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain.To evaluate the efficacy of thoracic paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture (...) on acute and chronic post-thoracoscopic surgery pain in patients undergoing VATS.A randomized prospective double-blinded trial.Assiut University Hospitals, Orman Cardiology Hospital.Sixty adult patients underwent elective VATS surgery under general anesthesia randomly allocated into 2 groups; Group I received thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough
Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal painAcute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.To investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.Prospective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological (...) , and analytical data were collected.We studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1-9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD
Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages e47–e49 Is Low-Dose Ketamine an Effective Alternative to Opioids for AcutePain? x Jonathan M. Kirschner , MD (EBEM Commentator) , x Benton R. Hunter , MD (EBEM Commentator) Department (...) of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN DOI: | Publication History Published online: December 11, 2018 Expand all Collapse all Article Outline Take-Home Message In adult emergency department (ED) patients with acutepain, low-dose intravenous ketamine (0.3 to 0.5 mg/kg) may provide pain relief within 10 minutes that is similar to that of single-dose intravenous morphine (0.1 mg/kg). Methods Data Sources A medical librarian searched MEDLINE, EMBASE, Scopus, Cochrane
Chronic use of tramadol after acutepain episode: cohort study. To determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids.Observational study of administrative claims data.United States commercial and Medicare Advantage insurance claims (OptumLabs Data Warehouse) January 1, 2009 through June 30, 2018.Opioid-naive patients undergoing elective surgery.Risk of persistent opioid use after discharge for patients treated with tramadol alone (...) =0.013).People receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acutepain as for other short acting opioids.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http
Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain Subdissociative-dose ketamine (SDDK) is used to treat acutepain. We sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain.This study was a randomized double-blind placebo-controlled trial conducted May 2017 to June 2018 at a public teaching hospital (ClinicalTrials.gov #NCT02920528). The primary endpoint was a 20-mm decrease on a 100-mm visual analog scale (VAS) at 60 (...) minutes. Power analysis using three groups (0.5 mg/kg ketamine, 0.25 mg/kg ketamine, or placebo infused over 20 minutes) estimated that 96 subjects were needed for 90% power. Inclusion criteria included age > 18 years, chronic pain > 3 months, and acute exacerbation (VAS ≥ 70 mm). Pain, agitation, and sedation were assessed by VAS at baseline and 20, 40, and 60 minutes after initiation of study drug. Telephone follow-up at 24 to 48 hours used a 10-point numeric rating scale for pain.A total of 106