Skin tears are a common injury treated in the elderly in the emergency department (ED). Often the skin is paper thin, and the area involved can have a large flap. By the time the patient has arrived, the may blood have dried with a retracted and rolled-in skin flap. Often the surface area is too big and skin to thin to inject local anesthesia around the entire site.
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Severe constipation, requiring fecal disimpaction and rectal enemas, can be excruciatingly painful for patients. Administering sedatives and opioids to help alleviate this pain poses a challenge, because many of the patients are elderly and tend to be more sensitive to these medications. Furthermore, there may be increased vagal tone when straining, leading to hypotension and bradycardia and which can result in defecation-related syncope. 1 Also, opioids can exacerbate constipation. Herein we present 2 cases and tricks on achieving better pain control.