Presenter: COL Chester C. Buckenmaier, MD - WRAMC
Lecture: Acute Pain in Medicine in the Field
Deployed to Afghanistan with the British. US would not allow him to provide pain management necessary.
Level 1 (Battlefield) – Ketamine IV/nasal, Fentanyl lollipops, Morphine, Splinting, Reassurance. No intrathecal morphine because of bimodal respiratory depression.
Level 2/3 (FST/CSH) – OR, blood products, diagnostic imaging, ICU, regional anesthesia, Acute Pain Service. In all US soldiers in whom pain management was started and/or regional pain management catheters were placed, these efforts were stopped and catheters were pulled when they arrived at US CSH in Bagram.
For Brits – (US) Military Pain Infusion System, nerve stimulation, ultrasound, IV paracetamol (acetaminophen), IV diclofenac. De-emphasize opiods secondary to overuse, abuse, and dependence.
Level 4 (Landstuhl) – US soldiers arrived in agony. Morphine wouldn’t hold. Flight nurses didn’t know what to do since docs at Bagram discontinued effective pain management efforts. Many consequences of untreated pain – especially psychological.
Level 5 – (CONUS)
Relief of pain and suffering is our primary objective and obligation as physicians.
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