Introduction: Pain Management (05:15)

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Pain is the most common memory a patient has of their hospital stay. This course will explore the management, monitoring, and medications available to treat pain, agitation, and delirium. Learn how to determine half-life, steady state, and creatinine clearance.

Clinical Practice Guidelines (09:06)

Pain, delirium, and agitation can interact. Barriers to effective pain management can be lack of knowledge of the provider, personal or cultural biases, an inadequate quality improvement process, or an inability to report. Clinicians need to recognize that the patient is experiencing pain, prioritize its mitigation, treat, and prevent its reoccurrence.

Pain Assessment (05:46)

Routinely monitor patient for pain, using a combination of vital signs, observational pain scales, critical care pain observational tool, and the Face, Legs, Activity, Cry, and Consolability Scale (FLACC). Assess before and after giving medication.

Pain Management: Opioid Medication (13:23)

Opioid receptors in the brain, spinal cord, and gastrointestinal (GI) tract respond to a stimulus minimizing the sensation of pain. Guidelines recommend IV medications should treat non-neuropathic pain in the critical care unit; consider prescribing Gabapentin or Carbamazepine in conjunction with opioid medication for neuropathic pain. Types include Fentanyl, Morphine, Hydrocodone, Methadone, and Remifentanil.

Pain Management: Opioid Abuse (16:54)

Patients may experience respiratory depression and slurred speech. Bunavail is a combination of Buprenorphine and Naloxone that does not release the narcotic if not used appropriately. Treatments are on the market for Opioid Induced Constipation; the Centers for Disease Control provide guidelines for prescribing opioids.

Pain Management: Non-opiate Analgesics (12:26)

Types include Acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, muscle relaxants, anticonvulsants, Capsaicin, and analgesics. An increase in dosage does not increase analgesia but increases side effects.

Agitation Management: Sedation (17:48)

Minimal, moderate, and deep sedation can be administered to ameliorate agitation. Causes include untreated pain, delirium, hypotension, hypoglycemia, and alcohol or drug withdrawal. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) can monitor depth.

Delirium Management (18:34)

The four characteristics of delirium are consciousness disturbances, cognition changes, develops over a short time, and fluctuates; types include hyperactive, hypoactive, and mixed. Guidelines recommend routine monitoring and using the Confusion Assessment Method (CAM) and the Intensive Care Delirium Screening Checklist (ICDSC) for the Intensive Care Unit (ICU). Do not administer Haloperidol if at all possible.