Patient selection: adult trauma patient arriving at the Emergency Department
Parameters:
(1) body weight in kilograms
(2) physiologic status based on Glasgow Coma Scale, heart rate, systolic blood pressure and acute mental status
A patient was classified as having unstable physiology if any of the following were present:
(1) Glasgow Coma Scale 3 to 8
(2) heart rate < 60 or > 120 beats per minute (if unexplained by chronic condition)
(3) systolic blood pressure < 90 mm Hg (if unexplained by chronic condition)
(4) abnormal acute mental status (psychosis, intoxication, head injury, metabolic disorder)
A patient was classified as having normal physiology if all of the following were present:
(1) Glasgow coma score 14 or 15
(2) heart rate from 60 to 120 beats per minute
(3) systolic blood pressure normal for patient (> 120 mm Hg for most patients)
(4) absence of acute mental status changes
If the person could not be classified into either of these groups then the person was classified as having stable physiology.
Management of the patient:
(1) Intubation if Glasgow coma score < = 8.
(2) Do not administer analgesia if the patient has unstable physiology.
(3) If physiology is stable or normal, then give analgesia based on body weight if pain present (see table below).
(4) Continuously monitor the patient's physiologic status.
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Body Weight
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Fentanyl IV Every 5 Minutes prn Pain
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<= 40 kg
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10 to 25 micrograms
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> 40 kg
|
25 to 50 micrograms
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