Analgesia in the emergency medical service: comparison between tele-emergency physician and call back procedure with respect to application safety, effectiveness and tolerance.

[Analgesia in the emergency medical service: comparison between tele-emergency physician and call back procedure with respect to application safety, effectiveness and tolerance]. Anaesthesist. 2019 Sep 05;: Authors: Gnirke A, Beckers SK, Gort S, Sommer A, Schröder H, Rossaint R, Felzen M Abstract BACKGROUND: Acute pain is a common reason for calling emergency medical services (EMS) and can require medication depending on the pain intensity. German EMS personnel feel strong pressure to reduce a patient's pain but are restricted by law. Currently, German federal law only allows the administration of opioid-containing drugs by or on the order of a physician, while in other European countries (e.g. Switzerland and The Netherlands) the administration of opioid-based analgesia by trained and certified paramedics is common practice. Consequently, a patient in Germany experiencing acute pain needs the attendance of an emergency physician in EMS missions. According to international standards pain reduction on the numeric rating scale (NRS) score by ≥2 or a NRS score ≤4 at the end of the patient transport is considered to be adequate. OBJECTIVE: Comparison of two different algorithm-based concepts for analgesia with consultation of a physician analyzing the efficacy, tolerance and safety of application. MATERIAL AND METHODS: In a retrospective cohort study in two different regions, two physician-supported a...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research

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Conclusion: This investigation can offer a reliable basis for the effectiveness and safety of IFB in treating the PELD pain. Trial registration: This study protocol is registered in Research Registry (researchregistry5985).
Source: Medicine - Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research
Authors: Matchanov O, Nelson P Abstract In perioperative settings where a patient under general anesthesia, presentation of serotonin syndrome might be far from the "classical" description of this potentially fatal condition. A patient who manifested signs of serotonin toxicity during an intravenous anesthetic, remifentanil, is presented. At the time of surgery, the patient was being treated with tramadol for pain management. The patient displayed myofasciculations on both gastrocnemius muscles confirmed electromyographically. All other conventional signs of serotonin syndrome were absent except hypotensi...
Source: The Neurodiagnostic Journal - Category: Neurology Tags: Neurodiagn J Source Type: research
The objective of this study was to investigate the efficacy of liposomal bupivacaine (LB) in patients undergoing lumbar spinal fusion. Summary of Background Data: Historically, posterior spinal fusion has been recognized as a particularly painful surgery. Postoperative pain limits early patient mobilization and discharge, and negatively impacts patient satisfaction. Local infiltration of anesthetic agents combined with postoperative multimodal pain management is common. On the basis of existing data, the liposomal formulation of bupivacaine might play a role in promoting faster recovery during the immediate postoperativ...
Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: PRIMARY RESEARCH Source Type: research
So this is actually an anesthesia/pain management case, but has strong cross-application to EM (or anyone doing LPs). Patient had a spinal epidural injection. Died of meningitis about a week later. Plaintiff attorney says its because they used betadine, not chlorhex for sterilization. Expert witness claims the same thing in his opinion (likely paid a huge amount) Only problem? Chlorhex says don't use near the meninges. However, some research showing the Chlorhex is actually better at... Med Mal Case: Meningitis [Do you use betadine or chlorhex for LP?]
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Emergency Medicine Source Type: forums
Alert: rant ahead. Early in my career working in persistent pain management, it was thought that “chronic pain is chronic pain is chronic pain” and pretty much anything that helped one person would help the next. Over time we’ve learned a lot more about persistent pain: the mechanisms differ a lot between neuropathic mechanisms and nociplastic mechanisms. Even within these groups, the mechanisms are very different. We’ve also learned a lot more about the psychosocial variables that are associated with prolonged disability and distress when pain persists. Some of the earliest work by Turk and coll...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Groupwork Interdisciplinary teams Pain conditions Research Science in practice Source Type: blogs
We present a report of two cases that highlight the efficacy of the ESP block as an early postoperative "rescue" regional anesthetic technique in lumbar spine surgery. These cases demonstrate the potential effectiveness of a "rescue" use of the ESP block in patients having uncontrolled or poorly controlled pain in the early postoperative period with no evidence of significant side effects. PMID: 32884335 [PubMed]
Source: Local and Regional Anesthesia - Category: Anesthesiology Tags: Local Reg Anesth Source Type: research
CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR. PMID: 32877380 [PubMed - in process]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
Background: Total knee arthroplasty (TKA) is known to be a painful orthopedic procedure and moderate to severe pain is common, especially immediately postoperatively and during active motion. The aim of the present study was to compare epidural analgesia (EA) and adductor canal block (ACB) techniques with regard to early period pain levels, need for additional opioids, and ambulation and functional scores in patients who had undergone primary TKA. Methods: Approval for the study was granted by the Changji Branch of the First Affiliated Hospital of Xinjiang Medical University. Written informed consent will be obtained ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research
CONCLUSIONS: Despite the use of single RF should not be recommended for the screening process in clinical practice, the combination of multiple RFs to enhance diagnostic accuracy is promising. Moreover, the identified RFs could be a baseline to develop a screening tool for patients with TLP. Implications for rehabilitation Differential diagnosis and screening for referral are mandatory skills for each healthcare professional in direct access clinical settings, and should be the primary step for an appropriate management of a patient with signs and symptoms mimicking serious pathologies in thoracolumbar region. Clinical rea...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
In this study, we aimed to compare the analgesic efficacy of the US-guided mTLIP block and wound infiltration following lumbar disc surgery. METHODS: 60 patients aged 18-65 years, ASA classification I-II, and scheduled for lumbar disc surgery under general anesthesia were included in the study. US-guided mTLIP block was performed via the lateral approach in group T (n=30), and wound infiltration was performed in group W (n=30). Opioid consumption, postoperative pain scores and adverse effects of opioids, such as allergic reactions, nausea, and vomiting, were recorded. RESULTS: Opioid consumption and the use of resc...
Source: Agri Dergisi - Category: Anesthesiology Tags: Agri Source Type: research
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