Management of Pain

KEY POINTS

  • Comfort and reassurance are more important than drugs.
  • Protect them from the environment and from further injury.
  • Treating pain improves outcomes.

EXPLANATION

Managing pain in the outdoor setting can seem daunting. When confronted by someone with a broken leg, giving some paracetamol (acetaminophen) might seem a bit useless. However, it is not, and there is plenty that you can do to help your casualty.

The most important thing you can do is to provide reassurance. Hold the casualty’s hand and talk to them, tell them what is going on and what everyone is doing to help. This has been shown to reduce pain significantly, as well as to improve outcomes. If you are coordinating a rescue – assign someone to sit at the head of the casualty to talk them through the situation.

Think about what else you could do to make them more comfortable. Perhaps shelter? Warmth? Food or water? Helping them go to the toilet?

Protect them from further injury. This may mean putting on a sling, padding a wound or splinting a limb. Splinting is one of the most effective forms of pain relief.

Finally, if the casualty is alert (talking to you) and can swallow, then you might consider simple painkillers:

  • If they are over 50 kg, the appropriate doses of paracetamol and ibuprofen are 1g and 400mg respectively.
  • If they are under 50 kg then give half-doses.

Be careful with ibuprofen in asthmatics, as it can provoke an attack in some. The most pragmatic way around this is to ask the casualty if they have taken ibuprofen before – if they say no, don’t give it to them.

Avoid aspirin – it can worsen bleeding.