1. Goals and Objectives  At the end of this presentation, the viewer should be able to:  Recognize the barriers to adequate acute pain relief in the ED  Outline the consequences of poor pain management in the ED  Discuss the psychology of pain and how certain factors can influence the degree of pain that a patient will experience  Be aware of some emerging treatments that have the potential to improve acute pain management for ED patients

2. Pretest  True or False ?  Patients that are opioid tolerant are less sensitive to a given pain stimulus than non-opioid tolerant patients  True of False ?  Patients who are in significant pain are always tachycardic and hypertensive

3. Pretest  Which of the following are consequences of inadequate acute pain control in the ED? A. Tachycardia, hypertension, increased myocardial oxygen demand B. Sympathetic stimulation of GI tract leading to decreased motility C. Reduced immune and endocrine function D. Setting up the patient for chronic pain with “sensitization” E. All of the above

4. Post-Test Question #1  Which of the following are barriers to timely and appropriate acute pain control in the ED A. Frequent interruptions of ED providers and staff B. Low prioritization of pain treatment compared to “time dependent” treatments C. Physician desensitization given the ubiquity of pain related complaints in the ED D. Underutilization of acute pain protocols to make treatment a priority E. All of the above

5. Post-Test Question #2  Ultrasound Guided Peripheral Nerve blocks are not appropriate for which of the following patients: A. A patient who stepped on a piece of glass and has a large laceration on the plantar aspect of the foot B. A patient with an open fracture of the distal radius and decreased sensation in the thumb, index finger and middle finger of the hand C. A patient with a Boxer’s fracture of the 5 th metacarpal from punching a wall D. A patient with a closed trimalleolar ankle fracture after slipping on wet grass

6. Post-Test Question #3  The consequences of poor pain control in the elderly patients include: A. Increased length of hospitalization B. Missed physical therapy sessions C. Delayed ambulation D. Increased incidence of delirium E. All of the above