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NYERI
NYERI
Nyeri
Consequences of Inadequate
Pain Management
Serious medical complications
Impair recovery
Progress to chronic pain
NYERI
NEUROBIOLOGY OF PAIN
Pain
Descending
modulation
Ascending
input
Spinothalamic
tract
Dorsal Horn
Dorsal root
ganglion
Peripheral
nerve
Peripheral
nociceptors
Adapted from Gottschalk A et al. Am Fam Physician. 2001;63:1981, and Kehlet H et al. Anesth Analg. 1993;77:1049.
Trauma
Stage of
Nociception
12
OPIOID
- Systemic
- Epidural
- Subarach
PERCEPTION
Pain
Descending
modulation
Ascending
input
Ketamin, Tramadol
Clonidine
Dorsal
Horn
LOCAL ANESTHETIC
- Epidural
-Subarachnoid
-Peripheral nerve
block
Dorsal root
ganglion
TRANSMISSIO
N
Spinothala
mic
tract OPIOID
- Systemic
- Epidural
- Subarach
MODULATION
Ketamin,
Tramadol
Clonidine
Peripheral
nerve
LA
COX-1
COX-2
TRANSDUCTION
Peripheral
nociceptors
No
single drug can produce optimal analgesia without adverse
Adapted from Gottschalk A et al. Am Fam Physician. 2001;63:1981, and Kehlet H et al. Anesth Analg.
effect
1993;77:1049.
Trauma
PAIN ASSESSMENT
OPQRST
Onset : - suddenly or gradually?
- what where you doing when pain started
Provokes : - what provokes your pain
- what make your pain better or worse
Quality : - sharp or dull ? does your pain feel like?
Radiates : - does your pain radiate?
Severity : VAS/ FLACC/ Wong Baker Faces
Time : - How long ago it started?
PAIN SCALE
PAIN MANAGEMENT
Pharmacological treatment
Non-pharmacological treatment
Pharmacological treatment
NSAIDs
Nonselective
COX-2 selective
Opioids
Local anesthesia
Adjunctive therapy, Other.
BENEFITS OF MULTIMODAL
PAIN THERAPY
1
Morphine
Potentiation
NSAIDs,
acetaminophe
n,
nerve blocks
1
NON-PHARMACOLOGIC
TREATMENT
Physical
Massage
Heat and cold
Acupuncture
Behavioral
Relaxation
Art and play therapy
Biofeedback
Cognitive
Distraction
Imagery and Hypnosis
ALUR PENGELOLAAN
NYERI
4. Evaluasi selama 1x24 jam, bila tidak teratasi maka DPJP harus segera
konsultasi ke tim nyeri SMF terkait.
5. Bila selama 1x24 jam bila teratasi maka tim nyeri SMF
tak teratasi maka tim nyeri SMF tim nyeri RS
6. Bila nyeri teratasi , maka tim nyeri RS DPJP.
7. DPJP konsultasi ulang ke tim nyeri SMF jika diperlukan
DPJP bila
Matur nuwun