Although many advances in trauma care have occurred, traumatic aortic injuries remain a leading cause of death in trauma patients. For those who survive long enough to receive treatment, rapid identification of injuries, surgical intervention, and definitive care are critical. Assessment findings and diagnostic imaging are both necessary to rapidly identify aortic injury and select the proper intervention. Surgical options are now available that, for the appropriate patient with aortic injury, can eliminate the need for invasive surgery, decrease complications, and decrease recovery time.

Many hospitalized adults cannot reposition themselves in their beds. Therefore, they are regularly turned by their nurses, primarily to prevent pressure ulcer formation. Earlier research indicates that turning is painful and that patients are rarely premedicated with analgesics. Nonpharmacologic interventions may be used to help with this painful procedure. However, no published research was found on the use of nonpharmacologic interventions for turning of hospitalized patients. The objectives of this study were: 1) to describe patient pain characteristics during turning and their association with patient demographic and clinical characteristics; 2) to determine the frequency of use of various nonpharmacologic interventions for hospitalized adult patients undergoing the painful procedure of turning; and 3) to identify factors that predict the use of specific nonpharmacologic interventions for pain associated with turning. Hospitalized adult patients who experienced turning, the nurses caring for them, and others who were present at the time of turning were asked if they used various nonpharmacologic interventions to manage pain during the turning. Out of 1,395 patients, 92.5% received at least one nonpharmacologic intervention. Most frequently used were calming voice (65.7%), information (60.6%), and deep breathing (37.9%). Critical-care patients were more likely to receive a calming voice (odds ratio [OR] 1.66, p < .01), receive information (OR 1.62, p < .001), and use deep breathing (OR= 1.36, p < .05) than those who were not critical-care patients. Those reporting higher pain were consistently more likely to receive each of the three interventions (OR 1.01, p < .05 for all 3). In conclusion, nonpharmacologic interventions are used frequently during a turning procedure. The specific interventions used most often are ones that can be initiated spontaneously. Our data suggest that patients, nurses, and family members respond to patients' turning-related pain by using nonpharmacologic interventions.

The purpose of this secondary data analysis of findings from a larger procedural pain study was to examine several factors related to pain during tracheal suctioning. In addition to tracheal suctioning, other procedures studied included turning, wound drain removal, femoral catheter removal, placement of a central venous catheter, and wound dressing change. A total of 755 patients underwent the tracheal suctioning procedure that was performed primarily in intensive care units (93%). A 0–10 numeric rating scale, a behavioural observation tool, and a modified McGill Pain Questionnaire-Short Form were used for pain assessment. Pain intensity scores were significantly greater during the tracheal suctioning procedure (M = 3.96, S.D. = 3.3) than prior to (M = 2.14, S.D. = 2.8) or after (M = 1.98, S.D. = 2.7) tracheal suctioning. Few patients received analgesics prior to or during the procedure. Surgical, younger, and non-white patients reported higher pain intensities. Although mean pain intensity during tracheal suctioning was mild, almost the half of the patients reported moderate-to-severe pain. Individualized pain management must be performed by healthcare providers in order to respond to patients' needs as they undergo painful procedures such as tracheal suctioning.

ObjectiveAs part of a major study on procedural pain, perceptions of pain and responses to various procedures in younger and older adults were examined. Procedures included wound care, wound drain removal, tracheal suctioning, turning, femoral sheath removal and central line insertion. Pharmacological treatments of pain and procedural distress by age were also examined.DesignProspective, descriptive-correlational.SettingCritical and acute care units in acute care hospitals.ParticipantsAcute and critically ill adults undergoing a procedure (wound care, wound drain removal, tracheal suctioning, turning, femoral sheath removal and central line insertion). There were 5957 participants in the sample, 3126 younger (18–64 years) and 2831 older adults (+65 years).MethodsPain intensity, behaviours and quality were measured prior, during and after the procedure.ResultsData showed pain intensity was greatest during the procedure, but did not differ according to age. More younger than older patients received analgesics; however, use of analgesics in both was minimal. Pain quality words and pain behaviours observed were similar in both groups. Procedural distress was mild but significantly greater in younger than older patients.ConclusionThese data show pain is greatest for both groups during the procedure. In addition, more persons in the younger group receive analgesics, although the mean dosage is not significantly different. Younger patients report greater distress during procedures than older ones, even though their pain intensity, words and behaviours are not different. Further attention needs to be given to understand these differences.

Objective Patients frequently display behaviors during procedures that may be pain related. Clinicians often rely on the patient's demonstration of behaviors as a cue to presence of pain. The purpose of this study was to identify specific pain-related behaviors and factors that predict the degree of behavioral responses during the following procedures: turning, central venous catheter insertion, wound drain removal, wound care, tracheal suctioning, and femoral sheath removal. Design Prospective, descriptive study. Setting Multiple units in 169 hospitals in United States, Canada, England, and Australia. Patients A total of 5,957 adult patients who underwent one of the six procedures. Interventions None. Measurements and Main Results A 30-item behavior observation tool was used to note patients' behaviors before and during a procedure. By comparing behaviors exhibited before and during the procedure as well as behaviors in those with and without procedural pain (as noted on a 0–10 numeric rating scale), we identified specific procedural pain behaviors: grimacing, rigidity, wincing, shutting of eyes, verbalization, moaning, and clenching of fists. On average, there were significantly more behaviors exhibited by patients with vs. without procedural pain (3.5 vs. 1.8 behaviors; t = 38.3, df = 5072.5; 95% confidence interval, 1.6–1.8). Patients with procedural pain were at least three times more likely to have increased behavioral responses than patients without procedural pain. A simultaneous regression model determined that 33% of the variance in amount of pain behaviors exhibited during a procedure was explained by three factors: degree of procedural pain intensity, degree of procedural distress, and undergoing the turning procedure. Conclusions Because of the strong relationship between procedural pain and behavioral responses, clinicians can use behavioral responses of verbal and nonverbal patients to plan for, implement, and evaluate analgesic interventions.