Podcast 139 – Opioid-Free ED with Sergey Motov - a podcast by Scott D. Weingart, MD FCCM
from 2014-12-14T18:56:25
Today I am joined by a good friend Sergey Motov, MD. Sergey is an EM doc with a particular interest in pain management in the ED. Sergey recently, as part of a approved study, ran an entire ED shift without a single administration of an opioid for pain. Can it be done?
The Pain-Free ED
Sergey has an amazing site, with resources and lectures: The Pain-Free ED
The Concept and Rationale of an Opioid-Free ED: Why do we need alternative to opioids in the ED?
No consensus on optimum opioid doses (weight-based, fixed, nurse initiated?)
* http://www.ncbi.nlm.nih.gov/pubmed/24210367
* http://www.ncbi.nlm.nih.gov/pubmed/23264318
* http://www.ncbi.nlm.nih.gov/pubmed/20825766
* http://www.ncbi.nlm.nih.gov/pubmed/16898939
Poor titration practices
* http://www.ncbi.nlm.nih.gov/pubmed/21908134
* http://www.ncbi.nlm.nih.gov/pubmed/20825766
Overdosing hydromorphone/ under-dosing morphine
* http://www.ncbi.nlm.nih.gov/pubmed/16898939
* http://www.ncbi.nlm.nih.gov/pubmed/19426295
Severe side effects ( especially geriatric patients)
* http://www.ncbi.nlm.nih.gov/pubmed/24033733
* http://www.ncbi.nlm.nih.gov/pubmed/24629443
Begetting Addiction
Regulatory concerns of prescribing opioids.
Concept of Multimodal Receptor/Channel Targeted Analgesia (RCTA)
Cox Inhibition
COX 1-2 - NSAIDS ( renal colic, back pain; by honoring “Analgesic Ceiling” concept)
COX 2 -Cox 3 - Acetaminophen (as well as TRPV1( capsaicin receprots) , cannabis, endogenous opioids)
* http://shortcoatsinem.blogspot.com/2012/03/iv-acetaminophen-all-rage.html
* http://www.anesthesiologynews.com/download/SR122_WM.pdf
* http://emj.bmj.com/content/early/2011/02/28/emj.2010.104687
* http://www.beat-journal.com/BEATJournal/index.php/BEAT/article/view/45
* http://www.ncbi.nlm.nih.gov/pubmed/25197573
* http://www.ncbi.nlm.nih.gov/pubmed/24381620
* http://www.ncbi.nlm.nih.gov/pubmed/22186009
NMDA antagonism- ketamine ( IV push, drip, continuous infusion as adjunct to opioids or single agents)
* http://www.ncbi.nlm.nih.gov/pubmed/25197290
* http://www.ncbi.nlm.nih.gov/pubmed/23602757
* http://www.ncbi.nlm.nih.gov/pubmed/23159425
Further episodes of EMCrit Podcast
Further podcasts by Scott D. Weingart, MD FCCM
Website of Scott D. Weingart, MD FCCM