Dec 1, 2020
Do you ever get overwhelmed with
all the ED analgesic options? In part 2 on ED Pain Management, Dr.
Sergey Motov helps break things down, reviewing a few cases and
finishing with Sergey’s 10 Commandments of ED Pain
Sergey's 10 Commandments of ED
- Titrate opioids regardless of initial dosing regimen:
weight-based, fixed, or nurse-initiated.
- Use alternatives (to IV) routes of analgesic administration:
PO, PR, IN, SubQ, nebulized, topical.
- Utilize sub-dissociative dose ketamine for selected acute and
chronic painful conditions.
- Educate patients about appropriate expectations of pain course
- Embrace a concept of channels/enzymes/receptors targeted
- Use NSAIDs based on their analgesic ceiling dose.
- Attempt to use non-opioid analgesics whenever possible.
- Promote nerve blocks for a variety of acute painful conditions
(trauma, infection, inflammation).
- DO NOT prescribe long-acting opioids, SR/ER opioids, or
fentanyl patches in the ED or at discharge.
- If indicated, DO prescribe a short course of immediate release
opioids (preferably morphine sulfate IR) at discharge and arrange
Resources and References
- Cisewski DH, Motov SM. EMRA Pain Management Guide.
EMRA. Dallas, Texas:2020.
• App version available within MobilEM at iTunes
and Google Play.
- Motov SM. PainFreeED.com.