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Discussion

Question to ER Nurses

I have a question for the Emergency Room nurses. I am in my BSN program and I have an AD degree. I use to work ER and we had to do 5 case studies in the program for ER patients. Most were in an unresponsive state. I got perfect scores except on pain assessment. How do you assess an unresponsive patient for pain? We always used sternum rubs and such to see if they had a response to deep pain stimulus, but how would you know they are in pain from the injury if they are unresponsive?

Thanks

~Willow

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    Please understand I know this is a stupid question but my teacher will not pass my main paper until I find an answer and put in the paper for this. If someone is truly unresponsive in my book they are feeling no pain. Because unresponsive means to deep stimuli.

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    I'm not an ER nurse, but I found this:

    Log In Problems

    You might have to register (it is free and a very good site). This is a very good article.

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    I know that if you think they're faking your assessment for responsiveness varies according to who's looking. ;)

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    • Author

    Thanks, I tried to tell this teacher in the real world in the ER if a patient is truly unresponsive you are not going to be giving pain medication because you could send them into respiratory distress and she said to pretend I was grr.

    Willow

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    Flacc

    face, legs, activity, cry, consolability

    of course VS as well: HR tachy could be pain, BP up could be pain, etc...

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    "If someone is truly unresponsive in my book they are feeling no pain"

    I don't know that that is a universally true statement. Most likely would need to find a cause for being unresponsive, making sure it's not an overdose, before medicating. Wouldn't want to medicate a head injury and change any neuro exam either.

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    Alterations in vital signs could be a clue. Also, I found this when I did a Google search on "assessing pain in unresponsive patients" and thought it was interesting:

    Potential Benefits of Bispectral Index Monitoring in Critical Care

    IMHO BIS is an overhyped and overpriced toy that just doesn't work the way it is intended. MMS: Error

    BIS was originally toted as end to anesthesia awareness, and it was later shown that there is no difference in outcomes with BIS or not in awareness. One of the biggest problems with BIS is it is only monitoring frontal lobe activity and most of the awareness that BIS is actually trying to monitor is in Reticular Activating System which is in the back of the brain. Reticular Activating System

    To answer the original question you would monitor a sympathetic response to pain as shown by an increase in HR/BP/RR. In the ER this can be really difficult unless you are sure that the cause of increased VS response is from pain and not some other pathological process. Depending on the circumstances you can also monitor FLACC scale.

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    We use a critical care pain observation tool in my ICU for unresponsive pts. It looks at facial expression, muscle tension, movement, vent tolerance, and vocalization (or lack thereof). I also look for increased HR, BP, and RR.

    HTH.

    :paw:

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    • Author

    Thanks everyone I appreciate it!

    ~Willow

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