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This chapter focuses on sore throat caused by viral or bacterial infection. It assumes that clinicians exercise appropriate precautions about airway management and possible complicating diagnoses. The NSAIDs, most commonly ibuprofen, are usually recommended for pain treatment of mild-to-moderate viral or bacterial pharyngitis (PG) in both adults and children. Aspirin, commonly dosed at 400-800 mg orally, is an effective PG pain reliever and is associated with symptomatic improvement. Acetaminophen is an effective reliever of mild pain, providing better PG relief than placebo within as little as 15 minutes. Corticosteroids, administered IM or PO in single or multiple doses, hasten the onset of both partial and complete pain relief in adults. In children, the utility of dexamethasone probably mirrors that of use of corticosteroids in adults with PG. Benzocaine (delivered by lozenges or spray) is commonly used for PG pain, but there are little applicable data for this indication.
The NSAIDs and opioids figure prominently in the daily practice of EM. The gastrointestinal risks of NSAIDs are reduced by co-administration of gastroprotective therapy such as misoprostol or, preferably, proton pump inhibitors. The combination of NSAIDs and opioids fails to accrue additive (or synergistic) analgesic results. NSAIDs (and acetaminophen) will always claim one advantage over opioids: antipyresis. For most patients, the potential problems with opioids have little to do with efficacy in relieving pain. For short-term use as prescribed from the ED, the analgesic benefits of the opioids will counterbalance the risks foremost pregnant patients with pain uncontrollable by other means. Since most opioids are excreted to some degree in breast milk, opioids are best avoided in breastfeeding mothers. The controversy surrounding meperidine (pethidine) use in the ED is hard for acute care providers to avoid.
Aspirin is commonly administered for acute
coronary syndromes in the prehospital setting. Few
studies have addressed the incidence of adverse
effects associated with prehospital administration
of aspirin. Objective: To determine the incidence
of adverse events following the administration of
aspirin by prehospital personnel.
Multi-center, retrospective, case series that
involved all patients who received aspirin in the
prehospital setting from (01 August 1999–31
January 2000). Patient encounter forms of the
emergency medical services (EMS) of a metropolitan
fire department were reviewed. All patients who
had a potential cardiac syndrome (i.e., chest
pain, dyspnea) as documented on the EMS forms were
included in the review. Exclusion criteria
included failure to meet inclusion criteria, and
chest pain secondary to apparent noncardiac causes
(i.e., trauma). Hospital charts were reviewed from
a subset of patients at the participating
hospitals. The major outcome was an adverse event
following prehospital administration of aspirin.
This outcome was evaluated during the EMS
encounter, at emergency department discharge, or
at six and 24-hours post-aspirin ingestion. An
adverse event secondary to aspirin ingestion was
defined as anaphylaxis or allergic reactions, such
as rash or respiratory changes.
A total of 25,600 EMS encounter forms were
reviewed, yielding 2,399 patients with a potential
cardiac syndrome. Prior to EMS arrival, 585
patients had received aspirin, and 893 were
administered aspirin by EMS personnel. No patients
had an adverse event during the EMS encounter. Of
these patients, 229 were transported to
participating hospitals and 219 medical records
were available for review with no adverse
reactions recorded during their hospital
Aspirin is rarely associated with adverse events
when administered by prehospital personnel for
presumed coronary syndromes.