A patient is hospitalized following a motor vehicle accident in which he sustained a number of broken ribs, a fractured scapula and humerus requiring surgical repair. The patient has no medical comorbidities.
What would be a rational multimodal treatment plan for this patient?
a. application of coldThis is the best response.
All of these treatment modalities could be part of a rational treatment plan for this patient. Application of cold may reduce or relieve pain by decreasing sensitivity to pain, reducing muscle spasms, and providing a competing sensory experience. Cold can be delivered through simple devices such as ice packs, refrigerated gel packs, or even a damp towel or cloth dipped in ice water. Regional analgesia is often used in combination with medications to treat patients with acute and may reduce the requirements for systemic analgesics. Analgesics are the mainstay of the management of acute pain due to trauma or surgery. The use of combinations of drugs that work by different mechanisms often provides optimal relief with lesser side effects. Non-steroidal anti-inflammatory drugs inhibit the synthesis of prostaglandins which sensitize peripheral pain receptors. Systemic opioid analgesics act at multiple sites in the central nervous system and can provide relief of severe pain. The choice of opioid and the route of administration will depend on the intensity and duration of pain. If pain is continuous, dosing should be around the clock.
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