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Ca 25 % av multitraumepasienter fr smertebehandling p vei inn til sykehus. Bare halvparten av disse pasientene opplevde en reduksjon av smertene. Australske underskelser viser at mindre enn 50% av pasienter med femurfrakturer fr smertebehandling ute. Tysk underskelse viser at prehoispitaltjeneste med lege ikke gir god nok smertebehandling. I hele 80% av tilfellene var dosene feil. I Frankrike viser tilsvarende underskelser at under halvparten av barna fr opoider. I tillegg har mange leger drlig kunnskap om akutt smertebehandling prehospitalt. Sannsynligvis er det ikke mye bedre i Norge.PPX6F /$Fysiologiske konsekvenser av smerter%%(hDrlig/utilstrekkelig ventilasjon Frigjring av katakolaminer ! katabolsk tilstand ! ! oksygenforbruk og ! CO2 produksjon. Takykardi, hypertensjon ! kt risiko for myokardischemi. (>u P0  2   MedikamenterMorfin: Doser 2,5-5mg (0,1mg/kg) om gangen. Titreres opp til nsket effekt etter gjeldende prosedyrer (15-20mg). Maksvirkning etter ca 15 min. Obs respirasjon. Reverseres med Nalaxone. Fentanyl: 100 ganger s potent som morfin. Doser 0,05-0,1 mg (1-3 mcg/kg). Maks effekt etter 2-3 minutter. Minimal hemodynamisk effekt pga ingen histaminfrigjring i motsetning til morfin. Obs respirasjon. Reverseres med Nalaxone. Brukes ikke i vanlig ambulansetjeneste i Norge, men i luftambulansen. Ketamin: Doser 30-50mg (i innlandet iflg mom). Effekt etter ca 1 minutt. Meget potent . Pvirker respirasjonen i liten grad, mest positivt med kt respfrekvens og bronkodilatasjon. Bivirkninger er kt BT og puls, kt sliming og forvevrenging av syns og hrseloppfatninger.Psykiske bivirkninger kan motvirkes/dempes med midazolam eller diazepam. Skal ikke gis ved hyt BT, kjente aneurysmer, cardielle sykdommer, perforerende yeskader, obs hodeskader. P:q 2:. ^Hg 1  ' $  5Fordeler med smertelindringFornyde pasienter, lettere underske Amerikansk underskelse viser at pasienter som fr smertelindring ute, blir tatt bedre vare p inne og fr tidligere smertelindring i mottak. Redusere stressnivet til pasienten og dermed de negative fysiologiske prosessene. Z Kontraindikasjoner?Mistenkt hodeskade. Kan vre vanskelig gjre en nevrologisk underskelse. Mulig gi Nalaxone inne i tillegg til CT. Bevissthetsnivet i forkant er viktig. Magesmerter. Lenge vrt tradisjon for at opioider vanskeliggjr underskelse. Underskelser tyder p at dette ikke stemmer. Ogs her er det mulig reversere opioidene hvis det trengs for videre underskelser inne. Hemodynamiske ustabile pasienter. Oioider gitt i sm doser har hatt liten innvirkning p hemodynamikken, men m vre forsiktig. Ketamin kan vre foretrekke her. 0Z ZZWhm 0 0 -rsaker til at smertestillende ikke blir gitt..(Manglende kunnskaper? Trenger iv tilgang, tar tid Pasienten ber ikke om smertestillende, manglende smertediagnostikk, Smeteskalaen, VAS, kan vre til hjelp her. Konsultering, tar tid Holdninger til kjnn, kulturer, alder.,V \  InnlandetDelegering p to niver: Trinn 2: Kan gi morfin opp til 15 mg, men ikke til barn Trinn 3: Kan gi Ketamin og morfin til barn. Trinn 3 er paramedicutdannet ,o#  Konklusjon(  ` 3f` ]fff3` W.f36d` ff3fffe̙` 3f3` kuos` f___ff̙` /!fff3̙>?" dd@,? " xd@  d  " x@ d`vP n?" dd@   @@``PR    @ ` `p>> }<(  < < 6| " `   SKlikk for redigere tittelstil  ( < 0 " `  VKlikk for redigere tekststiler i malen Andre niv Tredje niv Fjerde niv Femte niv)     W < 6  #" `^ `  D*  < 6L #" `^   F*  < 6 #" `^ `  F* x < LA޽h ?ocean_pale#" @@ 3f80___PPT10. P:4 Havm  @=(  @ @ 67x "p x SKlikk for redigere tittelstil   @ 09x " `   x `,Klikk for redigere undertittelstil i malen- - @ \@ABCxDE k'<xx"^ @ 6 >x #" `^  x F*  @ 6lBx #" `^ ` x F*  @ 6XGx #" `^ ` x D* x @ LA޽h ?ocean_pale#" @@ 3f80___PPT10. 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