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Flashcards in RTS Pain - musculoskeletal conditions Deck (30)
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1

what are the 3 different types of headache?

Tension
migraine
cluster

2

describe the symptoms of a tension headache

pain - mild to moderate
generalised dull ache
band around head or pressure on head
bilateral

3

describe the symptoms of a migraine headache

mild- moderate severe pain - throbbing, worse when moving
unilateral
blind spots
flashing lights
photophobia
nausea
vomiting

4

describe the symptoms of a cluster headache

intense pain
unilateral
orbital pain
runny nose/eyes the same side as the pain

5

what are the common patient groups for each type of headache?

tension - most age groups
migraine - women more likely than men, (if first one and >50 refer)
Cluster- men more likely

6

how long are each type of headache generally?

tension - self limiting, can get worse as day goes on(rest helps)
migraine - lasts hours > 3 days, recurring
Cluster - 10 mins - 3 hours, same time of day and recurring

7

What types of medication could trigger headaches?

Nitrates (open up blood vessels)
contraceptive pill
HRT
overuse of painkillers

8

what sort of things can trigger migraines?

foods, activity, situation, stress, caffeine, cheese alcohol

9

what are the common causes of headaches?

stress, dehydration, fatigue, infection, eye strain, toothache, period, ears

10

name the locations of each type of headache

tension - back of head
migraine - one sided
cluster - eye area

11

red flags associated with headaches

ongoing severe pain lasting >4 hours
sudden onset
recent trauma
suspected depression
cluster headache
severe eye pain
vomiting,confusion, malaise
migraine occurring for first time aged >50
treatment fail

12

what is dental pain?

Intense throbbing pain in tooth or gum that may come suddenly and gradually get worse-
pain can spread to ear/jaw
worse when laying down
redness/swelling face
red gums
bad breath

13

symptomatic relief for dental pain

ENCOURAGE TO SEE DENTIST ASAP
Oral analgesics - 1st line - NSAIDS if no CI, then paracetamol or combination

Can also have a combination containing a mild opioid e.g co codamol - neurofen or dihydrocodeine - paramol

Other options-
- orajel - benzocaine 2-% w/w - numbs, anaesthetic
- anbesol liquid or gel - lidocaine hydrochloride 0.9%, chlorocresol 0.1%

14

Differentiate between acute and chronic pain

Acute:
- provoked by a disease or injury
- associated with muscle spasm/nerve activation
- self limiting
- serves a biological purpose

Chronic:
- Considered a disease state
- can arise from psychological state
- outlasts the normal time of healing
- serves no biological purpose

15

Define - sprain, strain, bruising

Sprain - overstretching or twisting ligaments
Strain - muscle or tendon injury with swelling & pain
Bruising - damage to capillaries causing blood leakage

16

what are the 3 phases of the healing process?

1. inflammation - lasting approx 72 hours - PRICE
2. tissue repair - lasts up to6 weeks
3. Change of scar tissue to a more ordered arrangement

17

What things should be considered when taking a patient history for musculoskeletal conditions?

improvement In 72 hours?
what caused it?
Has it happened before? previous injury? did it heal?
Drug history - recent new meds? e.g statins side effects are muscle pain, or blood pressure medications that lower BP light headed?

18

symptomatic treatment of musculoskeletal and what not to be used?

1. oral analgesics - para with topical NSAID
2. NSAIDS - topical analgesics BUT do not use topical NSAID with oral NSAID
DO not use aspirin

19

why should aspirin not be used in treatment of musculoskeletal ?

it affects clotting and bruising as it causes blood to become runny and pool in the area affected

20

what is the pain ladder for musculoskeletal?

mild /mod pain 2-5/10 - non opioids e.g paracetamol /NSAID

5-8/10 - mild opioids e.g codeine, dihydrocodeine & cocodamol

8-10 - strong opioids e.g morphine

21

In the first 72 hours of injury. - what should be done?

PRICE and HARM

22

what is PRICE?

p - protect from further damage e.g. support
r - rest
I- ice - reduces swelling and bruising - 15 mins every 2-3 hours, don't apply directly to skin
c - compress- elastic bandage, limit swelling, but not in sleep
e -elavate above heart level and support

23

what is HARM?

Do not do these -
H- heat - this increases blood flow and swelling
A- alcohol - increases bleeding and swelling
R- running - further damage
M- massage - swelling & bleeding as it breaks BV

24

what is rubefa and give examples?

causes warming of skin via vasodilation
masks the perception of heat
e.g
Methyl salicylate, nicrotinates, menthol, camphor, turpentine, capsaicin

25

give 5 examples of red flag symptoms in injury

severe and prolonged pain
unable to bare weight
head injury
fever, chills, malaise, passing out - infection signs
numbness

26

what medications can cause bruising?

warfarin
NSAIDS
steroids
carbimazole

27

symptomatic treatment of bruising

1. heparinoid - disperse the oedema
2. arnica - herbal
3. witch hazel - astringent and anti inflammatory

28

why must we detect where the lower back pain specifically is?

If low and radiating to arm/side. - heart attack
near kidneys-could be a water infection especially if they are going to toilet a lot and urine is dark

29

treatments of lower back pain

Oral - NSAIDS, - ibuprofen, diclofenac
Para

Topical: NSAID gels or creams if not oral, heat, rubefacients

30

treatments to help with rheumatism/arthritis OTC?

- glucosamine sulphate - anti inflammatory and help cartilage

- Chondroitin - in cartilage, to retain water

NICE guidance suggests not offering these for management as many studies show no improvement