(精选)疼痛科中抗生素使用(英文课件)Antibiotics and Pain Control教学课件.pptVIP

“It is, of course, a complete myth that a standard cause produces a standard pain. However the myth affects the reactions of patients, medical staff, and friends alike. If you walk into an accident and emergency department with a broken wrist, you are matching the pain you feel with the pain you expect to feel with a broken wrist. They rarely match. You may be astonished if it does not hurt. You feel additionally miserable if your pain reduces you to a helpless, weeping wretch. The nurses and doctors instantly spot that you have a wrist at a strange angle, make a diagnosis and assign you to a category. For them, a broken wrist comes with an appropriate package of pain and deserves a fixed protocol of action. You as an individual may be anxious, terrified, drunk, or sad, but for them you become ‘the broken wrist in cubicle 6’….”. Oral Transmucosal Fentanyl Citrate Fentanyl Transmucosal Lozenge FENTANYL Synthesized in Belgium in the late 1950s Highly lipophilic synthetic phenylpiperidine derivative 80-100 times more potent than morphine Selectively binds to mu-1 and mu-2 receptors OTFC OTFC Manufactured in 1980s FDA approval: Oralet?, 1993; Actiq? , 1998 Crystalline form of fentanyl citrate (raspberry lozenge on a plastic stick) Only 50% absorbed Transmucosal: 5-10 min onset of action (25% RAPID) Intestinal mucosa: Significant first pass metabolism (25% SLOW) DESIGN, SETTING, and PATIENTS 1600 mcg OTFC doses During missions in support of OIF (03 March - 03 May 2003) Clinical Practice Guideline resulted in N=22 (out of 69) Hemodynamically stable patients Isolated, uncomplicated extremity wounds Would not have otherwise required an IV catheter NRS 5 Kotwal R, O’Connor K, Johnson T, Mosely D, Meyer D, Holcomb J. “A Novel Pain Management Strategy for Combat Casualty Care during Operation Iraqi Freedom.” Annals of Emergency Medicine 44/2 (August 2004): 121-127. MAIN OUTCOME MEASURES Pain measured by verbal 0-to-10 pain scale Pretreatment 15-minutes post-treatme