RESUMO
Rib fractures are a common reason for hospital admission and are associated with significant morbidity and mortality. This article discusses the management of simple rib fractures and provides practical guidance for junior doctors involved in the care of these patients. Careful assessment to identify patients at high risk of complications is essential and calculation of a rib fracture score can aid management decisions. Pain from rib fractures can be severe and requires multimodal analgesia started promptly and proactively on hospital admission. This may include the use of regional anaesthetic techniques such as thoracic epidurals and erector spinae blocks for patients with significant chest trauma or those at high risk of pulmonary complications.
Assuntos
Analgésicos/uso terapêutico , Manejo da Dor/métodos , Fraturas das Costelas/terapia , Fatores Etários , Analgesia Epidural/métodos , Analgésicos Opioides/uso terapêutico , Humanos , Oxigênio/sangue , Estudos Retrospectivos , Fraturas das Costelas/complicações , Fatores de Risco , Índices de Gravidade do TraumaAssuntos
Analgésicos , Dor , Insuficiência Renal/complicações , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/classificação , Analgésicos/farmacocinética , Contraindicações de Medicamentos , Creatinina/metabolismo , Relação Dose-Resposta a Droga , Humanos , Dor/complicações , Dor/tratamento farmacológico , Manejo da Dor/métodos , Manejo da Dor/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Eliminação Renal/efeitos dos fármacos , Insuficiência Renal/metabolismoRESUMO
BACKGROUND: A clear imperative exists to optimize the preoperative pain management of hip fracture patients. Increasingly, fascia iliaca compartment blocks (FICBs) are being effectively utilized as an adjunct to oral analgesia in the emergency department. PURPOSE: We investigated the feasibility, safety, and delivery rate when junior doctors and specialist nurses are trained in FICBs delivery, alongside the introduction of a step-by-step proforma. METHODS: We conducted a retrospective study of hip fractures patients presenting preinterventions (n = 138) between October and December 2014 and postinterventions (n = 246) between April and August 2015. Outcomes analyzed included delivery frequency, anesthetic dosages used, and procedure documentation. RESULTS: Preintervention, FICB was performed in 40% (n = 51) of eligible patients, with an improvement to 72% (n = 160) postintervention. Postinterventions, 98% of FICBs were performed with the anesthetic dose recommended-a prescription between 75 and 100 mg of 0.25% levobupivacaine. No adverse patient outcomes, relating to the interventions implemented, were noted during the study period. CONCLUSION: Delivery of FICB by junior doctors and specialist nurses in the emergency department is feasible, safe, and improves the proportion of patients receiving blocks.