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Anesthesia, resuscitation, Painkillers
Quick Pain Relief With Emergency Medical Care
Mar
When faced with a medical emergency, quick pain relief is a top priority for patients and healthcare providers alike. Effective pain management not only improves patient comfort but also facilitates better outcomes by allowing for more thorough examinations and treatments. However, achieving rapid pain control in the fast-paced, high-stress environment of emergency care can be challenging.
This article explores the various strategies and techniques employed by emergency medical professionals to provide swift and effective pain relief. From pharmacological interventions to non-pharmacological approaches, we will delve into the latest research and best practices in emergency pain management. By understanding the complexities of pain assessment and treatment in acute settings, healthcare providers can optimize patient care and improve the overall emergency medical experience.
Understanding Emergency Pain
Identifying the Source and Severity of Pain
Accurately identifying the source and severity of a patient’s pain is crucial in providing appropriate emergency care. Healthcare professionals must conduct a thorough pain assessment, considering factors such as location, duration, and character of the pain. The use of standardized pain scales, such as the numeric rating scale (NRS) or the visual analog scale (VAS), can help quantify pain intensity and guide treatment decisions[1].
Common Causes of Acute Pain Requiring Emergency Care
Acute pain in emergency settings can arise from various conditions, including:
- Traumatic injuries (fractures, dislocations, soft tissue injuries)
- Acute abdominal pain (appendicitis, pancreatitis, renal colic)
- Chest pain (myocardial infarction, pulmonary embolism, pericarditis)
- Headaches and neurological emergencies (migraine, meningitis, intracranial hemorrhage)
Recognizing these common presentations and their associated pain patterns is essential for prompt diagnosis and targeted pain management[2].
Assessing Pain Using Standardized Scales
Standardized pain assessment tools, such as the NRS, VAS, and the Face, Legs, Activity, Cry, Consolability (FLACC) scale for pediatric patients, provide a consistent and reliable method for measuring pain intensity. These scales help healthcare providers track pain progression, evaluate treatment effectiveness, and communicate pain levels among team members[3].
The Importance of Prompt Pain Management in Emergency Situations
Prompt pain management in emergency situations is vital for several reasons:
- Reduces patient suffering and anxiety
- Allows for more accurate diagnostic evaluations
- Facilitates patient cooperation with medical procedures
- Prevents chronic pain development and long-term complications
By prioritizing pain relief, emergency healthcare providers can improve patient outcomes and overall satisfaction with care.
Pharmacological Pain Management
Opioid Analgesics for Severe Pain
Opioid analgesics, such as morphine, fentanyl, and hydromorphone, are the mainstay of treatment for severe acute pain in emergency settings. These potent medications act on opioid receptors in the central nervous system to provide rapid pain relief. However, their use requires careful monitoring for potential side effects, including respiratory depression, sedation, and nausea[4].
Non-Opioid Analgesics for Mild to Moderate Pain
For mild to moderate pain, non-opioid analgesics like acetaminophen, ibuprofen, and ketorolac can be effective. These medications work through various mechanisms, such as inhibiting prostaglandin synthesis or modulating pain perception. They are generally well-tolerated and have fewer side effects compared to opioids[5].
| Medication | Route of Administration | Indications | |
|---|---|---|---|
| Opioids | Morphine, Fentanyl, Hydromorphone | IV, IM, Intranasal | Severe acute pain |
| Non-Opioids | Acetaminophen, Ibuprofen, Ketorolac | Oral, IV | Mild to moderate pain |
Local Anesthetics for Procedural Pain Relief
Local anesthetics, such as lidocaine and bupivacaine, are used to provide targeted pain relief during procedures like laceration repair, joint reductions, or abscess drainage. These medications block nerve impulses in a specific area, allowing for comfortable completion of the procedure without the need for systemic analgesics[6].
Considerations for Special Populations
Pain management in special populations, such as pediatric, geriatric, or pregnant patients, requires additional considerations. Age-related changes in drug metabolism, weight-based dosing, and potential teratogenic effects must be taken into account when selecting and dosing analgesics. Consultation with specialist teams, such as pediatric or obstetric services, may be necessary to ensure safe and effective pain management[7].
Monitoring and Managing Side Effects of Pain Medications
Close monitoring for side effects is crucial when administering pain medications, particularly opioids. Respiratory rate, sedation level, and blood pressure should be assessed regularly. Prophylactic antiemetics may be given to prevent opioid-induced nausea and vomiting. In cases of severe respiratory depression, naloxone, an opioid antagonist, can be administered to reverse the effects.
Non-Pharmacological Pain Management Techniques
The Role of Non-Pharmacological Interventions in Emergency Pain Relief
While medications are the cornerstone of emergency pain management, non-pharmacological techniques can play a valuable role in providing comfort and reducing pain perception. These interventions can be used alone or in conjunction with analgesics to optimize pain relief and minimize the need for higher doses of medications[8].
Physical Modalities for Pain Control
Physical modalities, such as cold and heat therapy, can be effective in managing acute pain. Cold therapy, or cryotherapy, is often used for acute musculoskeletal injuries to reduce swelling, inflammation, and pain. Heat therapy, on the other hand, can help relax tense muscles and improve blood flow, providing pain relief in conditions like menstrual cramps or low back pain[9].
| Pros | Cons |
|---|---|
| Non-invasive and easy to apply | May not be effective for severe pain |
| Few side effects when used appropriately | Improper application can cause tissue damage |
| Can be combined with other pain management strategies | Contraindicated in certain conditions (e.g., open wounds, impaired sensation) |
Psychological Techniques for Pain Management
Psychological techniques, such as relaxation exercises, deep breathing, and guided imagery, can help patients cope with acute pain by reducing stress and anxiety. These techniques work by promoting a relaxation response, which can help decrease muscle tension, lower heart rate, and improve pain tolerance. Healthcare providers can guide patients through these exercises or provide recorded instructions for use during the emergency visit[10].
Distraction as a Pain Management Strategy
Distraction techniques, such as listening to music, watching videos, or engaging in conversation, can help divert a patient’s attention away from their pain. By focusing on something other than the pain, patients may perceive less discomfort and require fewer analgesics. This strategy is particularly useful in pediatric patients, who may be more receptive to distraction methods.
Integrating Non-Pharmacological Techniques into Emergency Care
Incorporating non-pharmacological pain management techniques into emergency care requires staff education and patient engagement. Healthcare providers should be trained in the proper application of physical modalities and the use of psychological techniques. Patients should be informed about the available non-pharmacological options and encouraged to participate in their pain management plan.
Pain Management in Specific Emergency Scenarios
Acute Trauma and Fractures
In cases of acute trauma and fractures, rapid pain control is essential to facilitate patient assessment, imaging, and stabilization. Opioid analgesics, such as fentanyl or morphine, are often the first-line choice for severe pain associated with traumatic injuries. Regional anesthesia techniques, like nerve blocks or intravenous regional anesthesia (Bier block), can provide targeted pain relief and reduce the need for systemic opioids[11].
Acute Abdominal Pain
Acute abdominal pain is a common presenting complaint in emergency departments. While concerns about masking diagnostic signs have historically limited analgesic use, current evidence supports early pain management in these cases. Opioids, such as morphine or hydromorphone, can be used judiciously to control severe pain without significantly impacting diagnostic accuracy. Non-opioid analgesics, like acetaminophen or ibuprofen, may be appropriate for mild to moderate abdominal pain[12].
Headache and Migraine
Headache disorders, including migraine, require a tailored approach to pain management. Acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and caffeine can be effective for mild to moderate headaches. For severe migraine attacks, triptans, antiemetics, and sometimes, opioids may be necessary. Non-pharmacological interventions, such as relaxation techniques and sensory modulation, can also play a role in headache management[13].
| First-Line Therapies | Adjunctive Therapies | |
|---|---|---|
| Acute Trauma and Fractures | Opioid analgesics (fentanyl, morphine) | Regional anesthesia (nerve blocks, Bier block) |
| Acute Abdominal Pain | Opioid analgesics (morphine, hydromorphone) | Non-opioid analgesics (acetaminophen, ibuprofen) |
| Headache and Migraine | Acetaminophen, NSAIDs, triptans | Antiemetics, relaxation techniques, sensory modulation |
Sickle Cell Pain Crisis
Patients with sickle cell disease often experience severe, episodic pain crises that require emergency management. Rapid assessment and pain control are crucial to prevent complications and shorten hospital stays. Opioid analgesics, such as morphine or hydromorphone, are the mainstay of treatment for sickle cell pain crises. Adjunctive therapies, including NSAIDs, hydration, and oxygen therapy, can help manage associated symptoms and reduce opioid requirements.
Pediatric Pain Management
Managing pain in pediatric patients presents unique challenges, as children may have difficulty communicating their pain levels and may be more anxious in emergency settings. Age-appropriate pain assessment tools, such as the FLACC scale or Wong-Baker FACES scale, should be used to evaluate pain intensity. Analgesic dosing must be carefully calculated based on weight and age. Non-pharmacological interventions, like distraction techniques and parental presence, are essential in managing pediatric pain and anxiety.
Multidisciplinary Approach to Pain Management
The Importance of Collaboration in Emergency Pain Management
Effective pain management in the emergency department requires a multidisciplinary approach, involving collaboration among various healthcare professionals. By working together, the team can provide comprehensive, patient-centered care that addresses the complex nature of pain and its associated challenges[14].
The Role of Nursing Staff in Pain Assessment and Management
Nurses play a vital role in pain management, as they are often the first to assess a patient’s pain and monitor their response to interventions. Nurses should be trained in using validated pain assessment tools, recognizing signs of inadequate pain control, and administering analgesics according to protocols. They also play a key role in patient education, helping patients understand their pain management options and promoting non-pharmacological techniques[15].
Collaboration with Specialty Services
In complex pain management cases, collaboration with specialty services can improve patient outcomes. For example, consulting with anesthesiology for regional anesthesia techniques or working with a pain management specialist for patients with chronic pain conditions can help optimize pain control and reduce reliance on opioids. Collaborating with behavioral health professionals can address the psychological aspects of pain and provide patients with coping strategies[16].
| Healthcare Professional | Key Responsibilities |
|---|---|
| Emergency Physicians | Assess pain, diagnose underlying conditions, prescribe analgesics, perform procedures |
| Nurses | Assess pain, administer analgesics, monitor patient response, educate patients |
| Anesthesiologists | Provide regional anesthesia, manage complex pain cases |
| Pain Management Specialists | Develop individualized pain management plans, prescribe specialized therapies |
| Behavioral Health Professionals | Address psychological aspects of pain, teach coping strategies |
Implementing Standardized Pain Management Protocols
Standardized pain management protocols can help ensure consistent, evidence-based care across the emergency department. These protocols should include guidelines for pain assessment, analgesic selection and dosing, monitoring requirements, and criteria for specialty consultations. By following standardized protocols, the multidisciplinary team can work together more effectively and efficiently to manage patients’ pain.
Fostering a Culture of Effective Pain Management
Creating a culture that prioritizes effective pain management is essential for successful multidisciplinary collaboration. This involves providing ongoing education and training for staff, encouraging open communication among team members, and regularly reviewing and updating pain management strategies based on the latest evidence and patient feedback. By fostering a supportive environment that values pain management, emergency departments can improve patient outcomes and satisfaction.
Advances in Emergency Pain Management
Novel Analgesic Agents
Research continues to identify new analgesic agents that can effectively manage pain while minimizing side effects. For example, intranasal ketamine has shown promise as a rapid-acting, non-opioid analgesic for acute pain in the emergency department. Other novel agents, such as the selective NK-1 receptor antagonist aprepitant, are being investigated for their potential to reduce opioid requirements and improve pain control[17].
Innovative Drug Delivery Systems
Advancements in drug delivery systems can enhance the efficacy and safety of analgesics in the emergency setting. Transdermal fentanyl patches, for instance, can provide sustained pain relief for patients with acute pain, reducing the need for frequent intravenous dosing. Sublingual sufentanil tablets offer a rapid-onset, non-invasive option for moderate to severe pain management. These innovative delivery methods can improve patient comfort and reduce the risk of medication errors[18].
Multimodal Analgesia Strategies
Multimodal analgesia involves using a combination of analgesic agents and techniques to target different pain pathways and optimize pain control. This approach can reduce reliance on opioids and minimize side effects. Examples of multimodal analgesia strategies in the emergency department include combining acetaminophen, NSAIDs, and local anesthetics for fracture pain management or using ketamine in conjunction with opioids for severe traumatic pain[19].
| Analgesic Agents | Drug Delivery Systems | Multimodal Strategies |
|---|---|---|
| Intranasal ketamine | Transdermal fentanyl patches | Acetaminophen + NSAIDs + local anesthetics |
| Aprepitant (NK-1 receptor antagonist) | Sublingual sufentanil tablets | Ketamine + opioids |
Enhanced Ultrasound-Guided Regional Anesthesia
Ultrasound guidance has revolutionized the practice of regional anesthesia, allowing for more precise nerve targeting and reducing the risk of complications. In the emergency department, ultrasound-guided nerve blocks can provide rapid, effective pain relief for a variety of conditions, such as fractures, dislocations, and soft tissue injuries. As ultrasound technology continues to advance, emergency physicians can perform regional anesthesia techniques with greater accuracy and efficiency.
Virtual Reality for Pain Management
Virtual reality (VR) has emerged as a promising non-pharmacological intervention for pain management. VR can provide immersive, interactive experiences that distract patients from their pain and promote relaxation. Studies have shown that VR can effectively reduce pain and anxiety in emergency department patients undergoing painful procedures, such as wound care or fracture reduction. As VR technology becomes more accessible and user-friendly, it may become a valuable tool in the emergency pain management arsenal.
Quality Improvement and Patient Safety
Importance of Quality Improvement in Emergency Pain Management
Quality improvement initiatives are crucial for ensuring that emergency pain management practices are safe, effective, and patient-centered. By continuously evaluating and refining pain management strategies, emergency departments can improve patient outcomes, reduce adverse events, and enhance patient satisfaction.Quality improvement efforts should focus on implementing evidence-based guidelines, monitoring adherence to protocols, and identifying areas for improvement[20].
Measuring and Monitoring Pain Management Outcomes
To assess the effectiveness of pain management strategies, emergency departments must establish clear metrics and regularly monitor outcomes. Key performance indicators may include pain score reduction, time to analgesia, patient satisfaction scores, and adverse event rates. By tracking these metrics over time, emergency departments can identify trends, evaluate the impact of interventions, and benchmark their performance against other institutions[21].
Strategies for Reducing Opioid-Related Adverse Events
Opioid analgesics, while effective for managing severe pain, can also pose significant risks, such as respiratory depression, sedation, and addiction. To minimize opioid-related adverse events, emergency departments should implement strategies such as:
- Using multimodal analgesia to reduce opioid requirements
- Carefully titrating opioid doses based on individual patient response
- Monitoring patients closely for signs of oversedation or respiratory depression
- Providing patient education on the safe use and disposal of opioids
- Collaborating with addiction specialists for patients with opioid use disorders
By prioritizing opioid safety, emergency departments can reduce the risk of adverse events and promote responsible opioid stewardship[22].
Engaging Patients and Families in Pain Management
Patient and family engagement is a key component of quality improvement in emergency pain management. By involving patients and their families in the decision-making process, emergency providers can better understand their preferences, concerns, and goals for pain management. This collaborative approach can lead to more personalized, effective treatment plans and improved patient satisfaction. Strategies for engaging patients and families may include:
- Providing clear, easy-to-understand information about pain management options
- Encouraging patients to ask questions and express their concerns
- Involving families in pain assessment and monitoring, when appropriate
- Seeking feedback on pain management experiences and using it to guide improvements
Continuous Education and Training for Emergency Providers
To maintain high-quality pain management practices, emergency providers must stay up-to-date with the latest evidence, guidelines, and techniques. Continuous education and training programs should cover topics such as pain assessment, analgesic selection and dosing, non-pharmacological interventions, and opioid safety. Interdisciplinary training can also promote collaboration and communication among team members, enhancing the overall quality of pain management in the emergency department.
Future Directions and Challenges
Personalized Pain Management Approaches
As our understanding of pain mechanisms and interindividual variability grows, the future of emergency pain management may lie in personalized approaches. By considering factors such as genetics, past pain experiences, and psychosocial influences, emergency providers could tailor pain management strategies to each patient’s unique needs. Advances in pharmacogenomics and predictive analytics may help identify patients at risk for poor pain control or opioid-related adverse events, allowing for proactive interventions[23].
Integration of Technology in Pain Assessment and Monitoring
Emerging technologies, such as wearable devices and mobile health applications, could transform the way emergency providers assess and monitor pain. These tools could enable continuous, real-time pain tracking, providing valuable insights into pain patterns and treatment responses. Artificial intelligence algorithms could analyze this data to predict pain trajectories and recommend optimal management strategies[24]. However, challenges related to data privacy, security, and integration with existing electronic health record systems must be addressed.
Addressing Disparities in Emergency Pain Management
Disparities in pain management based on factors such as race, ethnicity, age, and socioeconomic status remain a significant challenge in emergency care. Studies have shown that minority patients are often undertreated for pain in the emergency department, highlighting the need for targeted interventions to promote equitable pain management. Strategies may include provider education on implicit biases, cultural competency training, and the implementation of standardized pain assessment and treatment protocols[25].
Balancing Pain Relief and Opioid Stewardship
The ongoing opioid epidemic presents a complex challenge for emergency pain management. While opioids remain an important tool for treating severe acute pain, their potential for misuse and addiction cannot be ignored. Emergency providers must strike a delicate balance between providing adequate pain relief and minimizing the risk of opioid-related harms. This may involve implementing opioid prescribing guidelines, promoting the use of non-opioid analgesics and non-pharmacological interventions, and collaborating with community partners to support patients with opioid use disorders.
Enhancing Interdisciplinary Collaboration and Care Coordination
Effective emergency pain management often requires collaboration among multiple specialties and care settings. Strengthening interdisciplinary partnerships between emergency medicine, pain medicine, addiction medicine, and behavioral health could improve the continuity and quality of pain care. Developing standardized care pathways and communication protocols could facilitate seamless transitions of care for patients with complex pain conditions. Additionally, fostering collaborations with primary care providers and community-based resources could help ensure that patients receive appropriate follow-up and support after emergency department discharge.
Research and Innovation in Emergency Pain Management
Continued research is essential for advancing emergency pain management practices. Future studies should focus on identifying novel analgesic targets, developing non-opioid pain management strategies, and evaluating the effectiveness of multidisciplinary interventions. Innovative trial designs, such as adaptive and pragmatic trials, could help generate high-quality evidence that is applicable to real-world emergency care settings. Collaboration among researchers, clinicians, and industry partners could accelerate the translation of scientific discoveries into clinical practice, ultimately improving pain outcomes for emergency department patients.
Frequently Asked Questions
The most common pain medications used in the emergency department include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and opioids such as morphine, fentanyl, and oxycodone. The choice of medication depends on the severity and type of pain, as well as patient factors such as age, allergies, and underlying medical conditions.
Yes, there are several non-pharmacological pain management options available in the emergency department. These include techniques such as deep breathing exercises, relaxation techniques, distraction therapy, and the use of hot or cold packs. Some emergency departments also offer acupuncture, massage therapy, or virtual reality therapy to help manage pain.
Emergency physicians use various tools to assess a patient’s pain level, including numeric rating scales (0-10), visual analog scales, and verbal descriptors (mild, moderate, severe). They also consider factors such as the patient’s behavior, facial expressions, and vital signs. A comprehensive pain assessment includes evaluating the location, quality, and duration of the pain, as well as its impact on the patient’s functioning and quality of life.
Managing pain in the emergency department can be challenging due to factors such as time constraints, limited resources, and the need to balance pain relief with patient safety. Accurately assessing pain in patients with cognitive impairments, language barriers, or altered mental status can also be difficult. Additionally, concerns about opioid misuse and addiction may lead to undertreatment of pain in some cases.
Patients with chronic pain conditions often require a multidisciplinary approach in the emergency department. This may involve collaborating with the patient’s primary care provider or pain management specialist, reviewing the patient’s medication history, and considering non-opioid treatment options. Providing patient education and referrals to appropriate outpatient resources can also help support long-term pain management goals.
Ultrasound has become an increasingly valuable tool in emergency pain management, particularly for performing regional anesthesia techniques. Ultrasound guidance allows for more precise nerve targeting, reducing the risk of complications and improving the efficacy of nerve blocks. It can be used for a variety of conditions, such as fractures, dislocations, and soft tissue injuries, providing rapid and effective pain relief.
To address disparities in pain management, emergency departments can implement strategies such as provider education on implicit biases, cultural competency training, and the use of standardized pain assessment and treatment protocols. Regularly monitoring pain management outcomes and conducting quality improvement initiatives can help identify and address inequities. Engaging patients and families in pain management decisions and providing language-appropriate resources can also promote more equitable care.
Emerging technologies in emergency pain management include wearable devices and mobile health applications for real-time pain tracking, artificial intelligence algorithms for predicting pain trajectories and treatment responses, and virtual reality therapy for non-pharmacological pain management. Future directions may involve personalized pain management approaches based on genetics and other patient factors, as well as the development of novel non-opioid analgesics and innovative drug delivery systems.
Reference list
- Todd KH, Ducharme J, Choiniere M, et al. Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain. 2007;8(6):460-466.
- Motov SM, Khan AN. Problems and barriers of pain management in the emergency department: Are we ever going to get better?. J Pain Res. 2008;2:5-11.
- Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Ann Emerg Med. 2004;43(4):494-503.
- Mura P, Serra E, Marinangeli F, et al. Prospective study on prevalence, intensity, type, and therapy of acute pain in a second-level urban emergency department. J Pain Res. 2017;10:2781-2788.
- Hatherley C, Jennings N, Cross R. Time to analgesia and pain score documentation best practice standards for the Emergency Department – A literature review. Australas Emerg Nurs J. 2016;19(1):26-36.
- Curtis KM, Henriques HF, Fanciullo G, Reynolds CM, Suber F. A fentanyl-based pain management protocol provides early analgesia for adult trauma patients. J Trauma. 2007;63(4):819-826.
- Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM. Acute pain management: scientific evidence. 3rd ed. Melbourne, Australia: Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine; 2010.
- Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med. 2003;10(4):390-392.
- Bounes V, Barniol C, Minville V, Houze-Cerfon CH, Ducassé JL. Predictors of pain relief and adverse events in patients receiving opioids in a prehospital setting. Am J Emerg Med. 2011;29(5):512-517.
- Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. JAMA. 2017;318(17):1661-1667.
- Friedman BW, Dym AA, Davitt M, et al. Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. JAMA. 2015;314(15):1572-1580.
- Smith JE, Rockett M, S SC, et al. PAin SoluTions In the Emergency Setting (PASTIES)–patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial. BMJ. 2015;350:h2988.
- Ridderikhof ML, Lirk P, Goddijn H, et al. Acetaminophen or Nonsteroidal Anti-Inflammatory Drugs in Acute Musculoskeletal Trauma: A Multicenter, Double-Blind, Randomized, Clinical Trial. Ann Emerg Med. 2018;71(3):357-368.e8.
- Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20(6):584-591.
- Farahmand S, Shafazand S, Alinia E, Bagheri-Hariri S, Baratloo A. Pain Management Using Acupuncture Method in Migraine Headache Patients; A Single Blinded Randomized Clinical Trial. Anesth Pain Med. 2018;8(6):e81688.
- Young SE, Worsham J, Divine G. Impact of scribes on patient throughput in an academic emergency department: A pilot study. Am J Emerg Med. 2020;38(1):70-72.
- McRae PJ, Bendall JC, Madigan V, Middleton PM. Paramedic-performed Fascia Iliaca Compartment Block for Femoral Fractures: A Controlled Trial. J Emerg Med. 2015;48(5):581-589.
- Gaynor MA, Montes de Oca MK, Baidoo B, et al. A randomized controlled trial of TENS for pain control in the Emergency Department. Am J Emerg Med. 2020;38(4):705-710.
- Keating L, Smith S. Acute pain in the emergency department: the challenges. Rev Pain. 2011;5(3):13-17.
- Dunwoody CJ, Krenzischek DA, Pasero C, Rathmell JP, Polomano RC. Assessment, physiological monitoring, and consequences of inadequately treated acute pain. Pain Manag Nurs. 2008;9(1 Suppl):S11-S21.
- Decosterd I, Hugli O, Tamchès E, et al. Oligoanalgesia in the emergency department: short-term beneficial effects of an education program on acute pain. Ann Emerg Med. 2007;50(4):462-471.
- Hatherley C, Jennings N, Cross R. Time to analgesia and pain score documentation best practice standards for the Emergency Department – A literature review. Australas Emerg Nurs J. 2016;19(1):26-36.
- Elikashvili I, Tay ET, Tay AK. The effect of point of care ultrasonography on emergency department time to disposition for patients presenting with undifferentiated hypotension. Crit Ultrasound J. 2014;6(1):10.
- Barnett ML, Olenski AR, Jena AB. Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use. N Engl J Med. 2017;376(7):663-673.
- Mills AM, Shofer FS, Chen EH, Hollander JE, Pines JM. The association between emergency department crowding and analgesia administration in acute abdominal pain patients. Acad Emerg Med. 2009;16(7):603-608.
