- Because the vast majority
of patients present to the Emergency Department for management of painful
conditions, and because of recent JCAHO initiatives, emergency physicians
continue to have a critical role in the overall scope of patient pain
management.
- Emergency physicians utilize
a basic set of principles, therapeutic agents, and guidelines in the
management of ED patients who require pain management.
- In general, emergency physicians
attempt to reduce pain levels through the use of oral acetaminophen,
NSAIDs, and combination narcotic preparations, as well as parenteral
ketarolac, morphine, and anti-emetics.
- Emergency physicians willingly
adopt new practice patterns that utilize methods and therapeutic agents
that are proven to be safe and effective, are easily understood, and
can be provided to a large number of undifferentiated patient populations,
including those who are experiencing pain.
- Pain management in the ED
can be enhanced through the development of systematic means of assessing
patient pain, rapidly utilizing available therapeutics, and consistently
evaluating the effectiveness of the interventions in relieving patient
pain.
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- Do emergency physicians
consistently provide quality pain management to patients who present
to the ED with painful conditions?
- What guidelines govern emergency
physicians' management of ED patients with pain, and how can these guidelines
be enhanced and broadly applied?
- Is it optimal that emergency
physicians practice with a basic set of therapeutic agents for pain
management, or should the range of therapies be expanded?
- Are there other therapies
that are being utilized by other general practitioners or specialists
that should be used by Emergency physicians when managing ED patients
with painful conditions?
- Are there verified systems
that already exist that could be easily implemented in the ED in order
to enhance the effectiveness of acute ED pain management?
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Emergency
Medicine Opportunities
- Academic emergency physicians
and Emergency Medicine organizations should actively explore through
quality research the way in which acute pain management can be optimally
delivered, including the identification of any disparities that
might exist based on ED patient demographics or practice settings.
- The American College
of Emergency Physicians could augment its policy statement on ED
pain management through the development of a clinical policy, and
academic emergency physicians could educate both residents in training
and practicing emergency physicians into the use of these guidelines.
- Emergency physicians
should evaluate the quality of the currently utilized therapeutics
and modalities for the management of ED patients who are experiencing
pain.
- Emergency physicians
should seek out the adoption of new pain therapeutics and modalities
so that ED patients who experience pain can be optimally treated.
- Emergency physicians
should become uniformly competent at the following aspects of ED
patient pain management:
- Providing a rapid
initial assessment of patient pain and the conditions that are
causing the pain.
- Developing a systematic
way in which patient pain can be alleviated prior to and during
the provision of necessary diagnostic procedures.
- Having a thorough
understanding of the relevant clinical features of therapeutics
and modalities that are currently available to treat ED patient
pain.
- Being able to learn
about new pain therapeutics as they become available.
- Consistently documenting
the effectiveness of the therapies that are provided in order
to alleviate ED patient pain.
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