In addition to the article below, I’ve included 6 of my posts on ultrasound guided procedures in Additional Resources.
Please review the article Ultrasound-Guided Nerve Block, an ED Opioid Alternative, AUGUST 15, 2018 from Anesthesiology News. Be sure and watch the video in the link. Here are some excerpts from the article:
As emergency physicians working with anesthesiologists to manage pain in the ED setting, we are on the frontlines of this urgent public health crisis. Pain, often severe, is the leading reason for ED visits, cited by 78% of patients.3 For decades, we were encouraged to aggressively manage pain as a “fifth vital sign.” While emergency physicians write less than 5% of opioid prescriptions,4 usually for short-term use, opioid-addicted patients often report their first exposure as being in the ED.5 Indeed, a recent study of Medicare beneficiaries suggests that for every 48 patients prescribed a new opioid in the ED who might not otherwise use these drugs, one will become a long-term user.6
[To reduce the use of opiods in the Emergency Department] St. Joseph’s Healthcare System in Paterson, NJ, [developed] a formal program focused on novel alternatives to opioids, such as nitrous oxide, trigger point injections, Lidoderm patches, anti-inflammatory medications, muscle relaxants and ultrasound-guided nerve blocks, whenever possible for appropriate patients. Here are some key takeaways from our experience.
Reducing ED Opioid Use by Nearly 50%
Launched in January 2016, our [St. Joseph’s Healthcare System] Alternatives to Opioids (ALTO) program mainly focuses on non-opioid treatment algorithms for five painful diagnoses frequently seen in the ED setting:
- renal colic or kidney stones;
- lumbar radiculopathy or sciatica;
- acute headache, including migraine and cluster headaches;
- musculoskeletal pain, such as back pain and shoulder pain; and
- joint and extremity fractures and joint dislocations.
To date, about 1,600 patients with these conditions have received alternative ALTO therapies in our ED. Compared to prescribing practices at St. Joseph’s in the three months before the ALTO program was introduced, opioid use for patients with these diagnoses has decreased by 47.7% in our ED, with no significant difference in patients’ pain scores and satisfaction for those who only received ALTO therapies, versus patients who received opioids.
And here is a link to Alternatives To Opiates (ALTOSM) Program Protocols [This link will download the protocols to your computer]. By Alexis LaPietra, DOMedical Director of Emergency Medicine Pain Management St. Joseph’s Regional Medical Center
Paterson, NJ
Additional Resources:
(1) Ultrasound Guided Line Placement From EMCrit 68 Live
Posted on September 15, 2017 by Tom Wade MD
(2) DIY Vascular Access Simulator For Use With Ultrasound – With Links To Additional DIY Simulators
Posted on March 17, 2017 by Tom Wade MD
(3) Placing A Femoral Line In Shock And Cardiac Arrest
Posted on March 15, 2017 by Tom Wade MD
(4) Use of Ultrasound To Confirm Correct Pediatric Intraosseous Placement
Posted on October 25, 2016 by Tom Wade MD
(5) DIY Medical Simulators For Ultrasound Guided Thoracentesis and For Escharotomy
Posted on June 4, 2016 by Tom Wade MD
(6) Ultrasound Guided Injection For Lateral Femoral Cutaneous Nerve Block For Meralgia Paresthetica
Posted on August 14, 2015 by Tom Wade MD
