I forget…what did that email say? oh yeah, its at

Archive for the ‘Analgesia & PSA’ Category

Opiates in IBD Flare: Gastroenterology Department Position

The conclusion of the QI committee was:

Narcotics are not contraindicated in acute abdominal pain in the ER setting. The literature supports that pain management, in combination with prompt diagnostic studies, does not delay or impair diagnosis or worsen outcomes.

The only exception are cases when toxic megacolon or pseudo-obstruction are suspected, espescially when non-operative management is being considered.

Tony Weiss

This slideset was presented at GI QA committee on the topic.

Written by reuben

June 24th, 2011 at 5:43 am

Posted in Analgesia & PSA,GI

Documenting PSA

When doing Procedural Sedation & Analgesia (formerly known as conscious sedation) at Sinai, the documentation is as follows:

1. Take the PSA physician checklist out of the bin. There is one bin in the med room on the adult side, and another bin next to the attending chair on the peds side. or print it out

2. Perform your PSA, using the checklist.

3. Have the BA scan the checklist into the chart.

4. Go into the patient chart in Epic.

4.1 Click on “Procedures.”

4.2 Click on “New Procedures.”

4.3 Click on “PSA/Conscious Sedation.”

4.4 Click on “The PSA physician checklist has been scanned into the chart.”

4.5 Click accept.

See attached picture. Note that the physician flowsheet is different than the nursing flowsheet, which is in Copies; this is for nurses to fill out.

Written by reuben

May 25th, 2011 at 11:01 pm

Posted in Analgesia & PSA

Sickle Cell Pain Crisis Admissions

For sickle cell pain crisis admissions, the chronic pain service wishes to be called instead of the hematology fellow. They will come down 24/7 to write analgesia orders. The resident/fellow covering this service carries a cell phone:

(646) 592-0084

If a sickle cell patient has another reason for admission (e.g. medically ill with an infection, chest crisis, hemolytic crisis, etc.) the case should be discussed with the heme fellow.

Written by reuben

May 12th, 2011 at 9:35 pm

MSH PSA Physician Checklist

This checklist should be filled out and scanned into the chart whenever procedural sedation and analgesia is used. What counts as PSA? Well it’s at the bottom of page 1:

PSA is being performed when, in a non-intubated patient, benzodiazepines and opioids are used in combination in sufficient doses to depress level of consciousness, or when ketamine is used in dissociative dose (>1 mg/kg IV), or when propofol or etomidate is used in any dose. Use of barbiturates to facilitate painless procedures (e.g. imaging studies) is also considered PSA.

This is the old checklist without ASA Class and Mallampati. We were asked to include ASA Class and Mallampati.

Written by reuben

May 9th, 2011 at 3:50 am

Posted in Analgesia & PSA

Pain Pagers

From: David L. Reich, M.D. Horace W. Goldsmith Professor and Chair of Anesthesiology Mount Sinai School of Medicine Stelian Serban, M.D. Interim Director of Pain Management Department of Anesthesiology To: All Attending Physicians, House Staff, Nurse Practitioners, and Physician Assistants Re: Pain Management Cellular Telephone Contact Numbers Date: March 29, 2011 In order to further our efforts to improve inpatient pain management at Mount Sinai, the Department of Anesthesiology FPA Pain Management Division has obtained cellular telephones to contact the Acute and Chronic Pain Services 24 hours per day, 7 days per week. Below are the new numbers for each service:

· Acute Pain Service: (646) 592-0145 (For patients within one week of surgery or interventional procedure)

 · Chronic Pain Service: Phone (646) 592-0084 (For patients with cancer pain, chronic non-malignant pain, or more than one week after surgery or interventional procedure)

The Mount Sinai Page Operator (212-241-1800) has these numbers should you need to be reminded of them. These telephone numbers should not be used for existing patients of other services, such as Palliative Care or voluntary pain management physicians. The FPA Pain Management team is committed to having a physician at the patient’s bedside within 20 minutes of receiving a call. Thank you for your efforts towards improving pain management at Mount Sinai.

Written by phil

March 29th, 2011 at 9:49 pm

Posted in Analgesia & PSA

Analgesia Policy

From Dr. Hill:

Below is the most important clip from this policy. Starting doses of opiate pain meds are LIMITED BY POLICY. If you give more than the recommended you have to document a rationale. Please adhere to the policy. Analgesia will be tailored for the patient’s pain, see Appendix 2 and 3 of policy below.

  • The recommended initial dose of intravenous morphine in adults is 4 mg (0.05-0.1 mg/kg/dose in pediatrics); up to 10 mg can be given in patients who have chronic pain
  • The recommended initial dose of intravenous hydromorphone is 0.5 mg (0.015mg/kg/dose in pediatrics) up to 1.4 mg in patients who have chronic pain
  • Patients receiving greater than an initial dose of 10 mg of morphine or 1.4 mg of hydromorphone should have a “clinical decision” note entered on the chart and consideration given to contacting the pain service
  • Repeat dosing of morphine or hydromorphone should not be more frequent than every 30 minutes; when given more frequently a “clinical decision” note should be entered on the chart
  • Patients requiring more than three doses of intravenous pain medications in a 3 hour period should be considered for a Pain Service consult

pain-management policy

Written by phil

March 24th, 2010 at 3:47 pm