ER 2: Pain cases

Study online at quizlet.com/_905g15

1. 2 yo fingers shut in 1) Need sedation prior to xray, 8. Closed, non- 1) Ketorolac IM/IV
drawer digital block displaced distal 2) Tylenol 1g PO
2) Midazolam (Versed), Fentanyl, or fibula fracture 3) Splint
Ketamine IM or IN 4) Home w/ NSAID, Tylenol, RICE, may
3) +/- LET/EMLA at base of finger add #8-10 Vicodin/Norco
for block, not on finger, toes, penis,
9. Dental Abscess 1) Dental block w/ Bupivicaine: local tx of
nose...
pain good
4) Home w/ NSAIDS, Tylenol
2) Oral NSAID, Tylenol 1g; oral steroid:
2. 18 mos old, hit coffee 1) LET/EMLA to area for 30 mins, dexamethasone 8-10mg PO
table w/ laceration to recheck 3) D/C w/ NSAID, Tylenol
forehead 2) Consider IM/IV Midazolam 4) Tx related to time to dentist: may add
(Versed) or Fentanyl or los- #8-10 Vicodin/Norco
dose/intranasal Ketamine
10. Dog bite 1) The size, mechanism and location make
3) Local infiltration of wound or
this wound special: will need xray, tons of
regional block
irrigation, exploratin
4) Consider "papoose", cosmetic
2) US guided radial nerve block: 8-10cc
repair
Bupivicaine after neurovascular exam
5) Home w/ NSAIDS
3) Can add Bupivicaine locally if
3. 78 yo falls w/ severe L 1) IVF, O2, Monitor anesthesia not complete
hip pain=fracture (low 2) Fentanyle 25mcg IV to start 4) No US, Bupivicaine local
BP) 2) US guided femoral nerve block 5) Home w/ NSAIDS, abx, splint
now!
11. Flu/PNA pleuritic 1) Ketorolac IM/IV + Tylenol 1g PO/IV
3) Consult ortho, discuss block
CP 2) D/C w/ NSAID, Tylenol, Tessalon
4) Caution! Pt will not feel
Pearls, not cough syrup
compartment syndrome after
femoral block! 12. Gout L Great toe 1) NSAID PO/IM: Ibuprofen as good as
Indomethacin
4. Acute low back pain 1) NSAID: oral or Ketoralac IM
2) Colchicine 1.2mg PO + steroids if
2) Tylenol 1g PO
severe (can give in ED)
3) Valium 5mg PO or Gabapentin
600mg PO 13. IVDU w/ L 1) Low dose Ketamine IM now
4) D/C w/ NSAIDS, Tylenol, muscle deltoid abscess 2) US guided IV access now an option
relaxant (Baclofen, Flexeril), 3) Ketoralac/APAP IV
lidocaine patches 4% 4) Best USG axillary nerve block: gets
5) Consider trigger point injection deltoid, also interscalene block great
Bupivicaine 5-7ml 5) Procedural sedation if IV, NPO, refuses
block
5. Car engine to ring 1) Digital block w/ Bupivicaine after
6) If no IV, not NPO: consider redose IM
finger neurovascular check & xray
Ketamine, then ring block, I&D
2) Repair, splint, NSAID/APAP Rx
7) Home w/ NSAIDS, APAP
3) Home w/ NSAIDS, Tylenol
8) Some EDs would begin w/ IM
6. Chin Laceration 1) Local infiltration w/ Lidocaine or Morphine/Benadryl before procedural
Bupivicaine w/ EPI (face bleeds sedation
alot)
14. Large burn to R 1) NSAID (oral/IM/IV) + Gabapentin
2) Home w/ NSAIDS
thigh 600mg PO, +/- Vicodin 1-2 tabs in ED
7. Chronic Knee pain 1) Intra-articular injection Bupivicaine 2) Home w/ NDSAIDS, local care of burn
form OA 2) Oral NSAID, no ketoralac d/t age,
15. L arm 1) Consider IN or IM Fentanyl or low-
renal risk
pain/deformity dose Ketamine prior to block
3) Short course of NSAIDS, Tylenol,
after fall 2) Hematoma block for reduction:
self care, ortho f/u
LET/EMLA to skin first
3) US guided block?
4) Reduction, splint, sling
5) Home w// weight adjusted NSAIDS,
self care instructions
16. L sided Pleuritic CP w/ low BP 1) Fentanyl 25-50mcg IV best opiate choice in hypotension
2) IVF to raise BP, IV Ketoralac/Tylenol for fever and pain
3) Wait for better BP before anxiolytics, treat the problem in the meantime
4) May add Zofran 4 mg IV, O2 will help
5) Consider Ketamine IV
17. Migraine HA 1) Migraine "cocktail": avoid opiates
-NSAID, antiemetic, antihistamine
2) Establish IV, give 1 L bolus (vomiting)
3) NSAID: Ketoralac 15mg IV
4) Antiemetic: Metoclopramide (Reglan) 10mg IV, Proclorperazine (Compazine) 10 mg IV
5) Antihistamine: Benadryl 25mg IV
6) RA: can give Triptan, steroids: Dexamethasone 8-10mg IV
7) Home w/ NSAIDS, antiemtic
18. Renal Colic 1) IV 1 L bolus, Ketoralac 15mg IV, Zofran 4mg IV, Tylenol 1000mg IV
2) Rescue: Morphine 4-8mg IV or Dilaudid .5-1mg IV or Ketamine 10mg IV
19. RLQ pain, vomiting 1) IV 1 L bolus, Sofran 4mg IV, Tylenol 1g IV, Ketorolac
2) Rescue: Morpine 4-8mg IV or Dilaudid .5-1mg IV or Ketamine 10mg IV: lower doses if opiate
naive, Benadryl 25-50mg IV
3) RA: if surgical, pt should be NPO
20. Shoulder dislocation after fall 1) IM/IV Ketamine or Fentanyl 25-50mcg (lowish BP)
from stool 2) Intra-articular injection of 8-10ml Bupivicaine: local tx is always good
3) Better: Brachial Plexus US guided regional block, No IV/IM, monitoring, ADEs...magic!
4) Last choice: procedural sedation to reduce
5) After reduction, home w/ NSAIDS/APAP/muscle relaxant, sling
21. Strep throat, pain and swelling 1) NSAID plus Tylenol w/ Codeine Elixir 15ml in ED
2) Steroid: IM Dexamethasone 6-10 + Abx
3) Home w/ NSAIDS/APAP