EMCrit Podcast 26 – Patient Controlled Analgesia by Edward Gentile

Even when we can’t cure a patient, we can relieve suffering. On average, we kind of stink at pain control in the ED. One physician, Dr. Ed Gentile, has created a simple path to optimal acute pain control in the ED. I heard this lecture on the EM:RAP podcast and got permission from Drs. Gentile and Herbert to repost it here. This is not a critical care topic per se, but it is applicable to the critically ill, the non-critically ill–basically any patient who is in pain in the ED.

Patient Controlled Analgesia

by Ed Gentile, MD

Need for an effective and efficient process is self evident .

Acute pain protocol for moderate/severe pain

  • Administer morphine 0.1 mg/kg IVP (If pt is > 55 y/o, substitute morphine 0.05 mg/kg IVP for this 1st dose)
    + diphenhydramine 0.5 mg/kg IVP
  • 7 minutes later the patient is asked, “Would you like more pain medicine?”
  • If the answer is yes, give a 2nd dose of morphine 0.05 mg/kg IVP
  • 7 minutes later, the patient is asked again, “Would you like more pain medicine?”
  • If the answer is yes, give a 3rd dose of morphine 0.05 mg/kg IVP
  • This continues every 7 minutes until the patient answers “no” to the question or the patient is asleep.

According to Dr. Gentile, “We don’t want to use the minimum, but the optimum pain dose for all patients.”

The protocol uses morphine because it has the longest half-life .

Diphenhydramine prevents antihistamine effects: nausea, vomiting, hypotension.

The protocol is unbiased and controlled by the patient!

Photo by Azarius
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Trackbacks

  1. […] [Click here to read more and hear the podcast] […]

  2. […] 6. Listen to Dr Gentile. […]

  3. […] 173 of the EMSEduCast on Pain Management our guest, Peter Canning, suggested this must listen podcast on Patient Controlled Analgesia. This is an amazing protocol/system for pain management that is based on the simple question, […]

  4. […] Patient Controlled Analgesia: EMCRIT Podcast Episode 26 […]

  5. […] Patient Controlled Analgesia: EMCRIT Podcast Episode 26 […]

  6. […] decide quando effettivamente ha ottenuto la giusta analgesia. Cosi l’anno scorso ho trovato su EMcrit il protocollo del Dr Gentile e mi è subito piaciuto. E’ indicato nel dolore moderato-severo , ed ecco in breve in cosa […]