liliaeliz
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| liliaeliz
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| mikky
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E...
E...post op retention due to analgesics...
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| WaqasQureshi
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the most common cause of zero urine post op is not due to analgesics. It is due to mechanical blockage of foleys plus she PASSED urine of 1 litre in RECOVERY ROOM. So answer is the same but reason is different
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| WaqasQureshi
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for the first question...
the
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| WaqasQureshi
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Topics: 5
Posts: 178
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for the first question...
the question is mentioning that the pain is Moderately sever and there
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| WaqasQureshi
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if there had been mild pain, paracetamol, COX II or oral ibuprofen would have been the choice. Now it is moderately severe so start with an ORAL medicine first....
preferably containing an opioid. Here the first choice is the only one going with this. So answer is A.
Another alternative cud be IM morphine for breakthrough pain and then start with IV morphine PCA.
Oral drugs have to be used first and if they fail then go for IV or IM drugs because they INVASIVE. A safe doctor practice 
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| WaqasQureshi
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there is an analgesia ladder. Please remember that.
it starts with NSAIDS and ends at fentanyl or anesthesia.
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| WaqasQureshi
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I am writing down the WHO analgesic ladder for others
Step One
The first step of the analgesic ladder is to use a non-opioid analgesic, for example paracetamol. Adjuvant drugs to enhance analgesic efficacy, treat concurrent symptoms that exacerbate pain, and provide independent analgesic activity for specific types of pain may be used at any step (eg NSAIDS).
Step Two
If the pain is persisting or worsening despite step one then a mild opioid such as codeine should be added (not substituted). Examples are combination preparations including co-proxamol and co-codamol.
Step Three
When higher doses of opioid are necessary, the third step is used. At this step an opioid for moderate to severe pain is used, eg morphine. The dose of the stronger opioid can then be titrated upwards, according to the patient's pain as there is no ceiling dose for morphine.
Guidelines for success with pain control
- Review all patients with pain regularly
- Try oral medication before parenteral (if possible)
- Treat underlying pathology wherever possible
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| liliaeliz
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thanks
but is not mechanical because the catheter was removed 12 hs. ago
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