About Opioids In a multi-trauma patient with a head injury

 In a multi-trauma patient with a head injury, opioids ;

• a)can be used to treat severe pain
• b)cannot be given to a ventilated patient
• c)can be given intramuscularly (IM) in the general ward
• d)will cause a change to ICP in a ventilated patient whose blood pressure remains constant
• e)will require the use of supplemental oxygen

 T F F F T

A multi-trauma patient with a head injury is likely to be in severe pain. Pain can increase ICP, therefore it is not only humane to treat the patient it is intracranially beneficial. However if opioids can be avoided by the use of nerve blocks this should be done. If not suitable, then small intravenous doses of an opioid can be used with the patient’s neurological status closely monitored in an intensive care or high dependency environment.

In patients who are being ventilated, it is quite safe to use opioids. Provided blood pressure does not fall, there is no change in ICP. If BP falls, autoregulation induces cerebral arterial vasodilatation, which, in a decompensated state, will raise ICP. A patient who is breathing spontaneously, may also have a fall in arterial saturation. This would exacerbate the effects of a rising CO.
Supplemental O2 should be given whenever possible to reduce the risk of hypoxia, known to occur when a patient is under the effect of an opioid falls asleep.