European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The aim of this study was to analyze the current practices on acute pain management of patients under opioid maintenance treatment (OMT), that is, buprenorphine or methadone. A total of 706 physicians were solicited through a national network to answer a survey about pain perception and analgesic strategies. Among the prescribers, 323 (46%) answered the survey: 131 (40%) physicians estimated that patients under OMT when exposed to an acute painful event feel more pain than other patients and 170 (53%) estimated that the patients felt the same amount of pain. ⋯ Among the second-line analgesic drugs, the WHO step 3 analgesics (mainly morphine) were the most commonly reported [221 physicians (68%)]. Overall, the results demonstrate the misconceptions of physicians on the pain tolerance of patients under OMT. Clinical studies and evidence-based guidelines are necessary to improve the therapeutic strategies for such patients in an emergency setting.
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Review Meta Analysis
Transcutaneous electrical nerve stimulation for relieving acute pain in the prehospital setting: a systematic review and meta-analysis of randomized-controlled trials.
Although medics in many services are equipped with pharmacological analgesia, legislative or logistical restrictions in some systems result in the need to rely on nonpharmacological avenues for the management of acute pain. Transcutaneous electrical nerve stimulation (TENS) has been proposed as an alternative to analgesic medication that could be feasible and effective in the prehospital setting. The aim of this systematic review was to determine the effectiveness and safety of TENS when administered by medics to patients with acute pain in the prehospital setting. ⋯ TENS was also effective in reducing acute anxiety secondary to pain. No safety risks were identified. When administered by medics in the prehospital setting to patients with acute pain, TENS appears to be an effective and safe nonpharmacological analgesic modality that should be considered by emergency medical services organizations in which pharmacological pain management is restricted or unavailable.
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Comparative Study Observational Study
Can a change in pH and pCO2 be used to monitor progress in patients undergoing noninvasive ventilation? A prospective cohort study.
The aim of this study was to compare changes in arterial and venous pH and pCO2 in patients undergoing noninvasive ventilation and having serial blood gases to assess ventilatory function. This was a prospective observational study of patients with acute respiratory distress. The outcome of interest was agreement in change in pH and pCO2 between arterial and venous specimens [mean difference; 95% limits of agreement (LoA)]. ⋯ The agreement between absolute change is reasonable for pH but not for pCO2. The direction of change agreed in most cases. Changes in venous pH and pCO2, in combination with clinical assessment, may be useful for assessing progress in patients undergoing noninvasive ventilation.