Analgesia for the critically ill patient

Jamie Riggs,Dominic Wang

doi:10.5206/uwomj.v87i1.1886

Abstract

You are the ICU fellow on call overnight at a tertiary care hospital. At approximately 2 AM, you receive a call from the emergency department (ED) with a consult. The ED resident gives you the following details: Mrs P is a 67 year old woman who presented recently with acute dyspnea and severe pain focused around an area of extensive erythema on her left arm. She has apulse rate of 115, respiratory rate 45 breaths per minute, temperature 39°C, blood pressure 95/65 mm Hg, and O2 saturation 68% on room air. The resident also notes areas of dark and yellowish tissue surrounding her left elbow, which are suspected to be necrotic. She is currently receiving 100% O2 via a high flow mask and fluid resuscitation via two peripheral IVs. She is experiencing severe pain, which she rates as 10/10, but is otherwise stable. You agree to have this patient transferred to your care. While she is on the way up you remind yourself of the key components of pain management in the critically ill patient.

Highlights

You are the intensive care unit (ICU) fellow on call overnight at a tertiary care hospital
Pain is defined by the International Association for the Study of Pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”[1]. Pain-related issues are a major cause of presentation to the emergency department (ED), with estimates as high as 70% of patients.[2]
Other studies have reported that 18% of ICU patients are at high risk for developing posttraumatic stress disorder 6 months after their stay due to memories associated with pain.[4]

Summary

Introduction

You are the ICU fellow on call overnight at a tertiary care hospital. At approximately 2 AM, you receive a call from the emergency department (ED) with a consult. The complications associated with poorly controlled pain in ICU patients must not be underestimated. Opioid medications (eg fentanyl, hydromorphone, morphine, methadone) are considered firstline medications for pain management in critically ill patients.[1] Choosing between the numerous opioid medications depends upon patient and medication characteristics.

Results

Conclusion