SlideShare une entreprise Scribd logo
1  sur  87
Symptom Control for Pediatric Patients   ,[object Object],Sponsored by -- The Jason Program creating a community of care
 
Why Are You Here? ,[object Object]
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cure vs. Palliation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Curative / Life-Prolonging Therapy Relieve Suffering - “Palliative” Care Presentation Death A Better Viewpoint
Accepting End-of-Life Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maintain Active Medical Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Death at Home vs. Hospital ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Care Issues ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oncologic Emergencies Immediate Intervention Required Common Less Common Pain Fever with Neutropenia or Splenectomy Airway Compression Spinal Cord Compression Brain Herniation Hyperleukocytosis
Pain Management ,[object Object],[object Object],[object Object],[object Object]
A Matter of Attitude ,[object Object],[object Object]
Barriers to Pain Control ,[object Object],[object Object],[object Object]
Treatment Principles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pediatric Pain Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHO 3-Step Ladder Step 1 - Mild Step 2 - Moderate Step 3 - Severe Aspirin Acetaminophen NSAIDs Codeine Hydrocodone Oxycodone Tramadol Morphine Hydromorphone Methadone Levorphanol Fentanyl Always consider adding an adjuvant Rx
Level I Medications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Level II and III Medications Pain Control Using Narcotics
Principles of Narcotic Dosing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Enteral Narcotics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parenteral Narcotics  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient-Controlled Analgesia ,[object Object],[object Object],[object Object],Medication   Base Rate   Bolus Dose   Lockout   “ Max”/Hr Morphine  .03 mg/kg  Same  6-10 min  .15 mg/kg Dilaudid  5 mcg/kg  Same  6-10 min  25 mcg/kg Fentanyl  1 mcg/kg  Same  6-10 min  4 mcg/kg
Equianalgesic Narcotic Dosing Source : McCaffery M, Pasero C. PAIN : Clinical Manual,  2nd Edition, Harcort Health Sciences Website, 2000.  www.harcourthealth.com/PAIN/index.html Oral/Rectal Dose (mg) Analgesic Parenteral Dose (mg) 3 Morphine 1 20 Codeine 12 3 Hydrocodone -- 0.75 Hydromorphone 0.15-(0.3 w/ PCA) 2 Oxycodone -- 2 Methadone 1 25 mcg/hr  Fentanyl Patch = 1 mg/hr IV MSO 4 -- Fentanyl 10-20 mcg 30 Meperidine 7.5
Common   Uncommon Constipation   Bad dreams / hallucinations Dry mouth   Dysphoria / delirium Nausea / vomiting   Myoclonus / seizures Sedation   Pruritus / urticaria Sweats   Respiratory depression   Urinary retention Opioid Side Effects Demerol  is not recommended due to its side effects Addiction  is NOT a side  effect
CNS Excitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Myoclonus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case I ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Addiction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pseudoaddiction ,[object Object],[object Object]
Tolerance ,[object Object],[object Object],[object Object]
Physical dependence ,[object Object],[object Object],[object Object],[object Object]
Substance Abusers ,[object Object],[object Object],[object Object],[object Object],[object Object]
Adjunctive Pain Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complimentary Interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],Summary
NIH Consensus Statement 21 “ The introduction of acupuncture into the choice of treatment modalities that are readily available to the public is in its early stages. Issues of training, licensure, and reimbursement remain to be clarified. There is sufficient evidence, however, of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”
ShotBlocker ,[object Object]
Use of the ShotBlocker “ In my office, using the ShotBlocker on over 100 patients, ages ranging from 4-18 years, I have noticed a significant reduction in the perceived pain from my patients receiving minor injections and immunizations. Although anecdotal, the response has been striking.” -- James Hunter, MD, PhD
Scientific Results Ordering Information Bionix Medical Technologies Phone: 1-800-551-7096 Fax: 800-455-5678 Web: www.bionix.com Pricing 25 per box ……………………………. $23.75 100 per box  ………………………… $85.00
Other Common Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Narcotic Pruritus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sedation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiology of Nausea ,[object Object],[object Object],Cortical  Anticipation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Vagal  • acetylcholine
Pharmacologic Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Not Recommended ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Federal Foolishness & Marijuana ,[object Object],[object Object],[object Object]
Neurologic Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anxiety ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Long Short
Depression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Breathlessness ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Constipation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When All Else Fails ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Barbiturates in the Care of  The Terminally Ill ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Barbiturates Are Justified  ,[object Object],[object Object],[object Object]
Venous Access ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Options PICC PAS Port Cook Broviac Port-a-Cath ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SQ VAD Port-a-Cath Mediport PAS port
Pain in Neonates ,[object Object],[object Object],[object Object]
Management of pain must be considered an important component of the health care provided to all neonates, regardless of their gestational age or severity of illness . Conclusion
Management of Pain ,[object Object],[object Object],[object Object],[object Object]
Continued ,[object Object],[object Object],[object Object],[object Object]
Pain Scales
Analgesic Medications
 
Nebulized Everything ,[object Object],[object Object],[object Object],[object Object]
Managing secretions 25 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Improve Mucociliary Clearance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Opioids for Dyspnea ,[object Object],[object Object],[object Object],[object Object]
Efficacy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nebulized Lidocaine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pediatric Safety ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Efficacy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Protocol Variations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Last Days of Living -  Social Aspects  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Last Days of Living - Medical Aspects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Two Paths to Death Usual Difficult Sleepy Lethargic Obtunded Comatose Death Restless Confused Tremulous Hallucinations Delirium Seizures Myoclonic Jerks
Thanks for listening
In Closing   ,[object Object],[object Object]
[object Object],[object Object]
Thanks for Listening Gary Allegretta, M.D. Kennebunk Pediatric Center Phone: 207-985-6770 E-Mail: [email_address] Fax: (206) 338-2426 Web:  www.jasonprogram.org Break Time!
Case I ,[object Object]
Case II ,[object Object]
Case III ,[object Object]
Case IV ,[object Object]
Case V ,[object Object]
Case VI ,[object Object],[object Object],Next Topic Beginning of Presentation

Contenu connexe

Tendances

1 adequate therapy for chronic non cancer pain
1 adequate therapy for chronic non  cancer pain1 adequate therapy for chronic non  cancer pain
1 adequate therapy for chronic non cancer pain
Puya Arash
 
Pediatric Pain Management
Pediatric Pain ManagementPediatric Pain Management
Pediatric Pain Management
yury
 
Some Spotlights about Pain management
Some Spotlights about Pain managementSome Spotlights about Pain management
Some Spotlights about Pain management
Ahmed El-Sawy
 

Tendances (20)

1 adequate therapy for chronic non cancer pain
1 adequate therapy for chronic non  cancer pain1 adequate therapy for chronic non  cancer pain
1 adequate therapy for chronic non cancer pain
 
Demystifying Opioid Rotations: The Phantom Menace or A New Hope
Demystifying Opioid Rotations: The Phantom Menace or A New Hope   Demystifying Opioid Rotations: The Phantom Menace or A New Hope
Demystifying Opioid Rotations: The Phantom Menace or A New Hope
 
Pain in the elderly
Pain in the elderlyPain in the elderly
Pain in the elderly
 
Adventures in Pharmacopalliation: Cancer Pain Management
Adventures in Pharmacopalliation: Cancer Pain ManagementAdventures in Pharmacopalliation: Cancer Pain Management
Adventures in Pharmacopalliation: Cancer Pain Management
 
Pain control in ED 2010
Pain control in ED 2010Pain control in ED 2010
Pain control in ED 2010
 
Pain management and prn medications
Pain management and prn medicationsPain management and prn medications
Pain management and prn medications
 
Pain and Sedation in Critically Ill Patients
Pain and Sedation in Critically Ill PatientsPain and Sedation in Critically Ill Patients
Pain and Sedation in Critically Ill Patients
 
Icu delirium 11.8.19
Icu delirium 11.8.19Icu delirium 11.8.19
Icu delirium 11.8.19
 
Supercharge your brain and ditch anxiety and depression for good!
Supercharge your brain and ditch anxiety and depression for good!Supercharge your brain and ditch anxiety and depression for good!
Supercharge your brain and ditch anxiety and depression for good!
 
Medical management of neuropathic pain
Medical management of neuropathic painMedical management of neuropathic pain
Medical management of neuropathic pain
 
Demystifying opioid rotation calculations v1.1
Demystifying opioid rotation calculations v1.1Demystifying opioid rotation calculations v1.1
Demystifying opioid rotation calculations v1.1
 
Role of Tricyclic AntiDepressant to break the Triad of Depression , Anxiety ...
Role of Tricyclic AntiDepressant to break the Triad of  Depression , Anxiety ...Role of Tricyclic AntiDepressant to break the Triad of  Depression , Anxiety ...
Role of Tricyclic AntiDepressant to break the Triad of Depression , Anxiety ...
 
11 depression therapies to get rid of depressive disorder today
11 depression therapies to get rid of depressive disorder today11 depression therapies to get rid of depressive disorder today
11 depression therapies to get rid of depressive disorder today
 
Pediatric Pain Management
Pediatric Pain ManagementPediatric Pain Management
Pediatric Pain Management
 
Hanipsych, pain & dep
Hanipsych, pain & depHanipsych, pain & dep
Hanipsych, pain & dep
 
Some Spotlights about Pain management
Some Spotlights about Pain managementSome Spotlights about Pain management
Some Spotlights about Pain management
 
Treatment Strategies for Women and Families with Substance Abuse
   Treatment Strategies for Women and Families with  Substance Abuse   Treatment Strategies for Women and Families with  Substance Abuse
Treatment Strategies for Women and Families with Substance Abuse
 
Cancer pain management
Cancer pain managementCancer pain management
Cancer pain management
 
1362576458 new look at painful neuropathy
1362576458 new look at painful neuropathy1362576458 new look at painful neuropathy
1362576458 new look at painful neuropathy
 
Optimising pain management by esther munyoro
Optimising pain management by esther munyoroOptimising pain management by esther munyoro
Optimising pain management by esther munyoro
 

Similaire à Support I I I

Palliative care monthly meeting
Palliative care monthly meetingPalliative care monthly meeting
Palliative care monthly meeting
ks_liang
 
Conventional Antipsychotics 2 19 2007
Conventional Antipsychotics 2 19 2007Conventional Antipsychotics 2 19 2007
Conventional Antipsychotics 2 19 2007
Flavio Guzmán
 

Similaire à Support I I I (20)

Opioid pain surgery2010
Opioid pain surgery2010Opioid pain surgery2010
Opioid pain surgery2010
 
Palliative care monthly meeting
Palliative care monthly meetingPalliative care monthly meeting
Palliative care monthly meeting
 
Palliative and End of life care.pptx
Palliative and End of life care.pptxPalliative and End of life care.pptx
Palliative and End of life care.pptx
 
Cancer Palliative Care
Cancer Palliative CareCancer Palliative Care
Cancer Palliative Care
 
Palliative Sedation
Palliative  SedationPalliative  Sedation
Palliative Sedation
 
Pain management strategies & effects on wellbeing
Pain management strategies & effects on wellbeingPain management strategies & effects on wellbeing
Pain management strategies & effects on wellbeing
 
Ha1migrainetensioncluster2021resident
Ha1migrainetensioncluster2021residentHa1migrainetensioncluster2021resident
Ha1migrainetensioncluster2021resident
 
Medication assisted therapies 2017
Medication assisted therapies 2017Medication assisted therapies 2017
Medication assisted therapies 2017
 
Chronic Pain: Dangers and Opportunities
Chronic Pain: Dangers and OpportunitiesChronic Pain: Dangers and Opportunities
Chronic Pain: Dangers and Opportunities
 
High Alert Medication
 High Alert Medication  High Alert Medication
High Alert Medication
 
High Alert Medication
 High Alert Medication  High Alert Medication
High Alert Medication
 
dr-170826095415.pptx
dr-170826095415.pptxdr-170826095415.pptx
dr-170826095415.pptx
 
Conventional Antipsychotics 2 19 2007
Conventional Antipsychotics 2 19 2007Conventional Antipsychotics 2 19 2007
Conventional Antipsychotics 2 19 2007
 
Conventional
ConventionalConventional
Conventional
 
END OF LIFE CARE.pptx
END OF LIFE CARE.pptxEND OF LIFE CARE.pptx
END OF LIFE CARE.pptx
 
Migraine Basics Presentation by Decontee "Dr. Dee" Jimmeh, MD
Migraine Basics Presentation by Decontee "Dr. Dee" Jimmeh, MDMigraine Basics Presentation by Decontee "Dr. Dee" Jimmeh, MD
Migraine Basics Presentation by Decontee "Dr. Dee" Jimmeh, MD
 
HIV Treatment Overview
HIV Treatment OverviewHIV Treatment Overview
HIV Treatment Overview
 
Principles for more cautious and selective opioid prescribing for chronic non...
Principles for more cautious and selective opioid prescribing for chronic non...Principles for more cautious and selective opioid prescribing for chronic non...
Principles for more cautious and selective opioid prescribing for chronic non...
 
Rethinking Critical Care Sedation
Rethinking Critical Care SedationRethinking Critical Care Sedation
Rethinking Critical Care Sedation
 
What To Do When Opioids Fail
What To Do When Opioids FailWhat To Do When Opioids Fail
What To Do When Opioids Fail
 

Dernier

Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
9953056974 Low Rate Call Girls In Saket, Delhi NCR
 
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
perfect solution
 

Dernier (20)

Call Girls Bangalore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Jabalpur Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
 
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
 
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
Mumbai ] (Call Girls) in Mumbai 10k @ I'm VIP Independent Escorts Girls 98333...
 
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
 
Call Girls Ooty Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Ooty Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Ooty Just Call 8250077686 Top Class Call Girl Service Available
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7Call Girls in Gagan Vihar (delhi) call me [🔝  9953056974 🔝] escort service 24X7
Call Girls in Gagan Vihar (delhi) call me [🔝 9953056974 🔝] escort service 24X7
 
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In AhmedabadO898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
O898O367676 Call Girls In Ahmedabad Escort Service Available 24×7 In Ahmedabad
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
 
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
College Call Girls in Haridwar 9667172968 Short 4000 Night 10000 Best call gi...
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
Call Girls Varanasi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 8250077686 Top Class Call Girl Service Available
 

Support I I I

  • 1.
  • 2.  
  • 3.
  • 4.
  • 5.
  • 6. Curative / Life-Prolonging Therapy Relieve Suffering - “Palliative” Care Presentation Death A Better Viewpoint
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. Oncologic Emergencies Immediate Intervention Required Common Less Common Pain Fever with Neutropenia or Splenectomy Airway Compression Spinal Cord Compression Brain Herniation Hyperleukocytosis
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. WHO 3-Step Ladder Step 1 - Mild Step 2 - Moderate Step 3 - Severe Aspirin Acetaminophen NSAIDs Codeine Hydrocodone Oxycodone Tramadol Morphine Hydromorphone Methadone Levorphanol Fentanyl Always consider adding an adjuvant Rx
  • 18.
  • 19. Level II and III Medications Pain Control Using Narcotics
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. Equianalgesic Narcotic Dosing Source : McCaffery M, Pasero C. PAIN : Clinical Manual, 2nd Edition, Harcort Health Sciences Website, 2000. www.harcourthealth.com/PAIN/index.html Oral/Rectal Dose (mg) Analgesic Parenteral Dose (mg) 3 Morphine 1 20 Codeine 12 3 Hydrocodone -- 0.75 Hydromorphone 0.15-(0.3 w/ PCA) 2 Oxycodone -- 2 Methadone 1 25 mcg/hr Fentanyl Patch = 1 mg/hr IV MSO 4 -- Fentanyl 10-20 mcg 30 Meperidine 7.5
  • 25. Common Uncommon Constipation Bad dreams / hallucinations Dry mouth Dysphoria / delirium Nausea / vomiting Myoclonus / seizures Sedation Pruritus / urticaria Sweats Respiratory depression Urinary retention Opioid Side Effects Demerol is not recommended due to its side effects Addiction is NOT a side effect
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36. NIH Consensus Statement 21 “ The introduction of acupuncture into the choice of treatment modalities that are readily available to the public is in its early stages. Issues of training, licensure, and reimbursement remain to be clarified. There is sufficient evidence, however, of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.”
  • 37.
  • 38. Use of the ShotBlocker “ In my office, using the ShotBlocker on over 100 patients, ages ranging from 4-18 years, I have noticed a significant reduction in the perceived pain from my patients receiving minor injections and immunizations. Although anecdotal, the response has been striking.” -- James Hunter, MD, PhD
  • 39. Scientific Results Ordering Information Bionix Medical Technologies Phone: 1-800-551-7096 Fax: 800-455-5678 Web: www.bionix.com Pricing 25 per box ……………………………. $23.75 100 per box ………………………… $85.00
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60. Management of pain must be considered an important component of the health care provided to all neonates, regardless of their gestational age or severity of illness . Conclusion
  • 61.
  • 62.
  • 65.  
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71.
  • 72.
  • 73.
  • 74.
  • 75.
  • 76.
  • 77. Two Paths to Death Usual Difficult Sleepy Lethargic Obtunded Comatose Death Restless Confused Tremulous Hallucinations Delirium Seizures Myoclonic Jerks
  • 79.
  • 80.
  • 81. Thanks for Listening Gary Allegretta, M.D. Kennebunk Pediatric Center Phone: 207-985-6770 E-Mail: [email_address] Fax: (206) 338-2426 Web: www.jasonprogram.org Break Time!
  • 82.
  • 83.
  • 84.
  • 85.
  • 86.
  • 87.

Notes de l'éditeur

  1. 1
  2. 2
  3. 3
  4. 4
  5. 5
  6. 6
  7. 7
  8. 8
  9. 9
  10. 10
  11. 13
  12. 11
  13. 14
  14. 15
  15. 21
  16. 23
  17. 24
  18. 25
  19. 26
  20. 27
  21. 18
  22. 19
  23. 20
  24. 28
  25. 29
  26. 30
  27. 32
  28. 33