Real World Emergency Nursing and Pain Management
Resource constrained nations
predominately have limited healthcare strategies which are often compounded by their
hardware and consumables diversit, not being expansive. In the aftermath of a natural disaster those
resources are limited further, by a combination of overwhelming use; and
limited availability due to the fragility of their supply chain.
Over the past few years I have deployed
with the New Zealand national medical response, to Solomon Islands & Vanuatu
following natural disasters. I wish to
share these experiences of real world emergency medicine and pain management
Turning Chest Trauma Patients Analgesia Strategies
on its Head
chest wall trauma is estimated to account for more than 15% of all emergency room
presentations1. It is well documented that length of stay and complications associated with rib fractures as
a result of blunt chest wall trauma doubles in the elderly and the co-morbid population
when compared to the under 55 year olds2.
the mortality rates reported varies significantly from 4% to 60%, Australasian and
UK studies are consistently reporting
mortality in the elderly at <10% for multiple rib fractures3,4,5.
statistics aren't a new finding nor are they surprising, yet we don't seem to be
abetting this. Given the platinum tsunami is gaining momentum maybe we need to
be more proactive than reactive?
has been seen as a cornerstone intervention within patient care with rib
fractures. I now want you to think about your current patient management and
introduce the concept that the analgesia ladder can be fraught with large gaps
- and if those gaps are big enough, complications evolve very quickly.
would like to take you on the Counties Manukau Health journey, looking at our
process and our (perceived or not) barriers and our new strategy.
R. Onan, B. Oz, K. Halezeroglu, S. (2009) Comprehensive analysis of 4205
patients with chest trauma: a 10-year experience. Interactive Cardiovascular and Thoracic Surgery 9(3): 450–453.
EM. Arneson, MA. Mick, CN & Jurkovich GJ. (2000) Rib fractures in the elderly. Journal of Trauma. 48(6) : 1040-6
T. Ikonen, A. Pyhältö, T. Handolin, L (2014) Factors Associated With
in-Hospital Outcomes in 594 Consecutive Patients Suffering From Severe Blunt
Scandinavian Journal of Surgery 104: 115–120.
CE. Hutchings, H. Evans P A (2013) Expert opinion of the risk factors for
morbidity and mortality in blunt chest wall trauma: Results of a national
postal questionnaire survey of Emergency Departments in the United Kingdom International Journal of the Care of the
Injured 44 (1) 56–59.
Manukau Health (2017) CMH Rib Fracture Presentations 2014-2016 via Collector Trauma