Analgesia in Adults in the Emergency Department
The objective of these guidelines is to outline the principles for the appropriate EmergencyDepartment (ED) assessment and management of pain in adults.These guidelines have been developed to act as a resource for medical and nursing staff andother members of the multidisciplinary ED team to guide them through the principlesassociated with achieving optimal pain control in adults. These guidelines are not intendedto replace clinical judgement.
PRINCIPLES OF ED PAIN MANAGEMENT IN ADULTS
ABCDE of Pain Assessment and Management
sk about pain regularly.
ssess pain systematically.
elieve the patient and family in their reports of pain and what relieves it.
hoose pain control options appropriate for the patient, pain level and setting.
eliver intervention in timely, logical and coordinated fashion.
mpower patients and their family.
nable them to control their pain to the greatestextent possible.
Pain is commonly under-recognised, under-treated and treatment may be delayed.
The experience of the member of staff triaging will help in estimating pain severity.
The assessment of pain includes a careful history and physical examination.
Pain assessment should undertaken in conjunction with assessment of vital signsand should be performed regularly.
Recognition and alleviation of pain should be a priority when treating ill and injuredpatients. This process should start at triage, be monitored throughout the pat
ED stay and finish with ensuring adequate analgesia at, and if appropriate, beyonddischarge.
Although the better known pain assessment scales have not been validated in theED setting, they are nevertheless currently satisfactory for the purpose of ED painassessment and management.
ED assessment of acute pain in adults using the Verbal Numerical Rating Scale (VNRS)No Pain Mild Pain Moderate Pain Severe PainVNRS = 0 VNRS = 1-3 VNRS = 4-6 VNRS = 7-10
It is important to re-assess the pain control within 30 minutes in severe andmoderate pain.
Following reassessment if analgesia is still found to be inadequate,stronger/increased dose of analgesics should be used along with the use of non-pharmacological measures. Simple analgesia, such as Paracetamol, may be used inaddition to opiate analgesia in severe pain.