Knee Dislocation in Emergency Medicine Medication

  • Author: H Brendan Kelleher, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Jan 11, 2011
 

Medication Summary

NSAIDs, analgesics, and anxiolytics are used to treat the pain associated with dislocations.

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Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients with injuries.

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Fentanyl citrate (Duragesic, Sublimaze)

 

Narcotic analgesic with greater potency and much shorter half-life than morphine sulfate. Excellent choice for pain management and sedation with its short duration time (30-60 min) and ease of titration. Easily and quickly reversed by naloxone. After initial dose, subsequent doses should not be titrated more frequently than q3h or q6h.

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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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Oxycodone and acetaminophen (Percocet)

 

Drug combination indicated for relief of moderately severe to severe pain. DOC for aspirin-hypersensitive patients.

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Acetaminophen and codeine (Tylenol #3)

 

Drug combination indicated for treatment of mild to moderately severe pain.

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Hydrocodone bitartrate and acetaminophen (Vicodin ES)

 

Drug combination indicated for relief of moderately severe to severe pain.

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Oxycodone and aspirin (Percodan)

 

Drug combination indicated for relief of moderately severe to severe pain.

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Anxiolytics

Class Summary

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

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Lorazepam (Ativan)

 

Sedative hypnotic in benzodiazepine class that has short onset of effect and relatively long half-life. By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation. Excellent for patients who require sedation for longer than 24 h. Monitor BP after administering and adjust as necessary.

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Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

These agents are used most commonly for the relief of mild to moderately severe pain. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.

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Ibuprofen (Ibuprin, Advil, Motrin)

 

DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, inhibiting prostaglandin synthesis.

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Ketoprofen (Oruvail, Orudis, Actron)

 

Used for relief of mild to moderately severe pain and inflammation. Administer small dosages initially to patients with a small body size, the elderly, and those with renal or liver disease. Doses higher than 75 mg do not increase its therapeutic effects. Administer high doses with caution and closely observe the patient for response.

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Flurbiprofen (Ansaid, Ocufen)

 

Has analgesic, antipyretic, and anti-inflammatory effects. May inhibit cyclooxygenase enzyme, inhibiting prostaglandin biosynthesis.

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Naproxen (Anaprox, Naprelan, Naprosyn)

 

Used for relief of mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, decreasing prostaglandin synthesis.

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Contributor Information and Disclosures
Author

H Brendan Kelleher, MD  Assistant Professor of Clinical Emergency Medicine, University of Southern California Keck School of Medicine; Assistant Residency Director, Department of Emergency Medicine, University of Southern California Los Angeles County Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Diku Mandavia, MD, FACEP, FRCPC  Attending Staff Physician, Department of Emergency Medicine, Cedars-Sinai Medical Center; Clinical Associate Professor of Emergency Medicine, Los Angeles County-USC Medical Center; Co-Editor, Color Atlas of Emergency Trauma

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  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Tom Scaletta, MD  Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of 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, University Hospitals, Case Medical Center

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.

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Types of knee dislocation.
Posterior knee dislocation.
Lateral knee dislocation (before reduction).
Open knee dislocation.
Lateral knee dislocation after reduction.
 
 
 
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