Analgesia in Chest Trauma
OVERVIEW
- chest trauma is very painful as rest is not possible, pain is experienced with every breath
- a multi-modal approach ideal with MDT involvement (ICU, anaesthesia and pain)
PRINCIPLES
Effective analgesia important to decreased incidence of complications:
- atelectasis
- pneumonia
- respiratory failure and mechanical ventilation
- MI
Analgesic techniques depends on these factors:
- type of injury
- interventions performed (e.g. drains, thoracotomy)
- allergies and adverse reactions
- co-morbid conditions (COPD)
- type of pain (somatic, neuropathic)
- associated injuries
- pre-existing chronic pain issues and tolerance
Analgesia needs to be adequate so patient can cough effectively and participate with physiotherapy
SPECIFIC THERAPIES
multimodal approach
- pharmacological
- physical
- procedural
- psychosocial
simple analgesics
- paracetamol, NSAIDs if not contraindicated – bleeding, renal impairment, gastric prophylaxis
Opioid analgesia
- tramadol (avoid if risk of seizures or serotonin syndrome)
- morphine
- fentanyl
- may require a PCA or infusion if ventilated
analgesic adjuncts
- alpha blockers — clonidine, demedetomidine
- neuropathic agents — gabapentin, amitryptilline
- ketamine
- lignocaine infusions
regional analgesia
- intercostal catheters
- paravertebral catheter
- thoracic epidural
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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