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بسم الله الرحمن الرحيم. وقل رب زدنى علماً. صدق الله العظيم. Acute pain service , clinical application in ICU. By Sahar Elkaradawy P rofessor in A naesthesia MRI, Alexandria University 2012. O bjectives. Acute pain service Why pain service should be built in our hospitals? And how?

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slide1

بسم الله الرحمن الرحيم

وقل رب زدنى علماً

صدق الله العظيم

acute pain service clinical application in icu

Acute pain service , clinical application in ICU

By

SaharElkaradawy

Professor in Anaesthesia

MRI, Alexandria University 2012

o bjectives
Objectives
  • Acute pain service
  • Why pain service should be built in our hospitals?
  • And how?
  • What pain service teamhas to do?
  • The pain management protocols in peri-operative field.
  • Multimodal analgesia and multidisciplinary approach for pain relief.
acute pain service
Acute pain service

It is peri-operative good quality service introduced by physicians and well trained nurse to educate patient about post operative pain and choose the best methods available to relieve his /her pain and speed up recovery.

  • Physicians
  • Patient Nurse

Documentations

Paperwork

Sheets

why pain service should be built in our hospitals
Why pain service should be built in our hospitals?

Aims of APS are to:

  • Reduce pain intensity and increases patient’s wellbeing.
  • Decrease morbidity and mortality
  • Speed up recovery
  • Decrease patient's short-and long-term use of healthcare facilities, and subsequent costs to society.
how can we build acute pain service
How can we build acute pain service?

Multidisciplinary approach:

  • Patient’s education ( audio- visual aids)
  • Personnel training (Physicians and nurses)
  • Protocols for management of pain. ( Sheets)
  • Concept of multimodal analgesia and perioperative rehabilitation
patients education
Patients’ education
  • Discuss pain issue with your patient. Patient can help if he understood methods to measure his pain
  • Patient’s education decreases anxiety and makes patient involved in postoperative pain management plans so his pain becomes easier to treat.
  • Booklet for education: postoperative pain,medicines for pain relief, analgesia and addition non-drug methods for pain relief ( appendix 1)
personnel training
Personnel training

Physician and nurse should to know:

Definition and pathophysiology of pain and understand consequences of unrelieved pain

Pain scales ( to measure pain)

Be familiar with the pharmacologic therapy ( drugs, side effects, how to manage)

Protocols of acute pain management

Multimodal analgesia

physician and nurse s hould to know
Physician and nurse should to know:
  • Definition.
  • Pathophysiology of pain.
  • Understand consequences of unrelieved pain.
definition of pain
Definition of pain
  • Unpleasant sensation associated with actual

or potential tissue damage.

slide17
SP and excitatory amino-acids prostanoids nitric oxid calcitonin gene related peptide are excitatory peptides that produce long lasting depolarization of DH neurons and facilitates transmission of impulses leading to production of central hypersensitization. Central hypersensitization can augment responses of DH neurons by up to 20 fold in amplitude and prolong responses even after cessation of peripheral impulse.
spinal cord
Spinal cord
  • Accentuation of pain
slide20

:Spinal cord

Accentuation of pain.

multimodal analgesia
Multimodal analgesia
  • The concept of multimodal analgesia involves the use of different classes of analgesics(NSAID,

Opioids, local anaesthetics and adjuvants e.g. alpha 2 agonist, neurontin)

  • Or different sites of analgesic administration

e.g. PNB or neuroaxial with iv PCA

  • Aiming to provide superior dynamic pain relief with reduced analgesic-related side effects.
consequences of postoperative pain

CONSEQUENCES OF POSTOPERATIVE PAIN

  • Inadequately controlled pain can:
  • Prolong recovery time
  • Delay return to normal living
  • Decrease satisfaction with care.
  • Increase the use of health care resources, thereby increasing total healthcare costs.
  • Lead to chronic pain specially after breast surgery, thoracotomy, and inguinal hernia
what physician and nurse should to do
What Physician and nurse should to do?:
  • Help in patients’ education
  • Decide with his patient a protocol for post operative pain relief.
  • Assess pain
  • Intraoperative and post operative pain management
  • Make sure that APS modality is working and patient is OK
  • Make sure that patient is stable before discharging home.
multimodal analgesia1
Multimodal analgesia
  • The concept of multimodal analgesia involves the use of different classes of analgesics(NSAID,

Opioids, local anaestheticsand adjuvants e.g. alpha 2 agonist, neurontin)

  • Or different sites of analgesic administration

e.g. PNB or neuroaxial with iv PCA

  • Aiming to provide superior dynamic pain relief with reduced analgesic-related side effects.
assessment of pain
Assessment of pain

Pain Intensity

slide36
This is an actual patient in the recovery room, minutes after surgery on her hand. She is smiling because she doesn't hurt, and she doesn't hurt because of post-operative pain programme application.

Acute postoperative pain management programme