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Pain management in acute orthopedic injury needs to be tailored to the presentation and patient. Subjective and objective assessment, in conjunction with pathophysiology, should be used to provide symptom control. Ideally, treatment should be administered in an escalating fashion, attempting to manage pain with the lowest dose of the safest medication available. There are also adjunctive therapies, including those that are nonpharmacologic, that can provide additional relief.

Author(s): Fischetti, Chanel; Kamyszek, Reed W.; Shaheen, Stephen; Oshlag, Benjamin; Banks, Adam; Blood, AJ; Bytomski, Jeffrey R.; Boggess, Blake; Lahham, Shadi | Abstract: Introduction: Sudden cardiac death is a rare cause of death in young athletes. Current screening techniques include history and physical exam (H and P), with or without an electrocardiogram (ECG). Adding point of care cardiac ultrasound has demonstrated benefits, but there is limited data about implementing this technology. We evaluated the feasibility of adding ultrasound to preparticipation screening for collegiate athletes.Methods: We prospectively enrolled 42 collegiate athletes randomly selected from several sports. All athletes were screened using a 14-point H and P based on 2014 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, ECG, and cardiac ultrasound.Results: We screened 11 female and 31 male athletes. On ultrasound, male athletes demonstrated significantly larger interventricular septal wall thickness (p = 0.002), posterior wall thickness (p l0.001) and aortic root breadth (p = 0.002) compared to females. Based on H and P and ECGs alone and a combination of H and P with ECG, no athletes demonstrated a positive screening for cardiac abnormalities. However, with combined H and P, ECG, and cardiac ultrasound, one athlete demonstrated positive findings.Conclusions: We believe that adding point of care ultrasound to the preparticipation exam of college athletes is feasible. This workflow may provide a model for athletic departments’ screening.

Chronic abdominal pain can be difficult to manage with regard to discharge planning and instructions. Medically, pain control should be given in the safest and smallest doses necessary. Narcotics and benzodiazepines should be avoided when possible. An empathetic approach and utilization of support systems can encourage patient independence in this multifactorial and overwhelming process. Referral to the appropriate clinicians for follow-up, including the gastroenterologist, gynecologist, urologist, psychiatrist, or primary care provider, facilitates ongoing treatment.