Category: Adult Analgesia

NSAIDS in high mechanism of injury

Question#: 513

Question:

The Analgesia Medical Directive does not include any relationship to the administration of Ibuprofen and high risk MOI. It would be nice to see a correlation between the C-spine study guidelines for high risk MOI and the administration of an anticoagulant to a patient in the field

Answer:

 

There are actually no high-quality studies looking at the relationship between possible C-spine injuries and the use of NSAIDS in the prehospital field. Whereas a closed head injury with suspected intracranial bleeding NSAIDS are considered contraindicated this is largely based on a theoretical risk of platelet dysfunction and increased bleeding times seen in patients. As the cranium is contained structure any even theoretical risk of increasing the contents already under pressure is contraindicated.

In non trauma patients there is no association found between NSAID usage and spontaneous ICH: https://www.ahajournals.org/doi/pdf/10.1161/01.str.0000054057.11892.5b#:~:text=Background%20and%20Purpose%E2%80%94Nonsteroidal%20anti,hemorrhage%20(ICH)%20are%20sparse.

For suspected spinal cord injury or nerve impairment presumably considered from hematoma or bleeding near the spinal cord causing nerve conduction impairment there is again no studies that are able to guide our management. In the case wherein a patient with shoulder pain after falling from a horse and has primarily arm related pathology (eg. Fracture with peripheral nerve impairment/entrapment) or brachial plexus injury that would not be considered a contra-indication to receiving NSAIDS for analgesia. If the patient was complaining of predominantly neck pain and had associated parathesias it may be prudent to withhold NSAIDS, although again this a theoretical risk and there is no literature to guide this decision. We applaud the critical thinking in these scenarios and advise that an opioid may be used in this case or a patch to the base hospital physician for discussion is always appropriate.

 

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