Hip Dislocation in Emergency Medicine Medication

  • Author: Edward T Tham, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Dec 6, 2010
 

Medication Summary

Administer adequate parenteral analgesia. The emergency physician, consultant, and patient must decide on the most appropriate type and place for reduction: open versus closed and emergency department versus operating room.

If a closed reduction is attempted in the ED, the patient requires procedural sedation. Procedural sedation policies should be established to define who can administer medication, who must monitor the patient, the classes and doses of procedural sedation medications, and the resources on hand for resuscitation.

In addition to airway protection and rescue, the procedural sedation goals must include pain relief, muscle relaxation, and procedure amnesia.

General anesthesia in the operating room may be required for patients with dislocations that are irreducible by closed means as well as for those with significant associated fractures, central dislocations, or associated neurovascular injury.

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Analgesics

Class Summary

Pain control is essential to good-quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. The analgesic must have a rapid onset, predictable action, and be easily titratable.

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Morphine sulfate (Duramorph, MS Contin, MSIR)

 

DOC for analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various IV doses are used; commonly titrated until desired effect obtained.

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Fentanyl citrate (Duragesic, Sublimaze)

 

More potent narcotic analgesic with shorter half-life than that of morphine sulfate. Suitable for procedural sedation analgesia. Excellent choice for pain management and sedation; has short duration (30-60 min) and easy to titrate. Easily and quickly reversed by naloxone.

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Meperidine (Demerol)

 

Narcotic analgesic with multiple actions similar to those of morphine. May produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine.

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Sedative hypnotics

Class Summary

Use these agents for procedural sedation with rapid onset and short duration.

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Propofol (Diprivan)

 

Phenolic compound; sedative hypnotic agent used for induction and maintenance of anesthesia or sedation; has anticonvulsant properties.

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Anxiolytics

Class Summary

Patients with painful injuries usually experience significant anxiety. Anxiolytics allow the clinician to administer a decreased dose of an analgesic to achieve the same effect.

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Diazepam (Valium)

 

By increasing activity of GABA, major inhibitory neurotransmitter, depresses all levels of CNS including limbic and reticular formation. Individualize dose and increase it cautiously to avoid adverse effects.

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Lorazepam (Ativan)

 

Sedative hypnotic in benzodiazepine class that has short onset of effect and relatively long half-life. By increasing activity of GABA, major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation. Excellent medication when patient needs to be sedated for >24 h.

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Contributor Information and Disclosures
Author

Edward T Tham, MD  Fellow in Emergency Ultrasound, Clinical Instructor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine

Edward T Tham, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM  Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Jerome FX Naradzay, MD, Paul Carter, MD, and Edward Newton, MD, to the development and writing of this article.

References

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A normal anteroposterior (AP) pelvis radiograph.
Right posterior hip dislocation in a young woman following a high-speed motor vehicle collision (MVC).
Fracture-dislocation of the right hip. The bony fragments are likely part of the acetabulum.
Posterior dislocation of right hip with acetabular fracture.
 
 
 
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