Wrist Dislocation in Emergency Medicine Medication

  • Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 18, 2011
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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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 these patients.

Acetaminophen and codeine (Tylenol #3)

 

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

Oxycodone and acetaminophen (Percocet)

 

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

Oxycodone and aspirin (Percodan)

 

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

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

 

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

Acetaminophen (Tylenol, Panadol, Aspirin-free Anacin)

 

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, those with upper GI disease, or those taking oral anticoagulants.

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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 tend to be patient specific, ibuprofen is usually the DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.

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, which inhibits prostaglandin synthesis.

Ketoprofen (Oruvail, Orudis, Actron)

 

Used for relief of mild to moderately severe pain and inflammation. Administer small dosages initially to patients with small body size, elderly persons, 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 patient.

Flurbiprofen (Ansaid)

 

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

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

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, 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

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, 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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References
  1. Hayden SR. A case of peri-lunate dislocation. J Emerg Med. Mar-Apr 1995;13(2):241. [Medline].

  2. Carter PR. Fractures and dislocations of the wrist. In: Common Hand Injuries and Infections. 1983:123-141.

  3. Mital RC, Beeson M. The Wrist and Forearm. Emergency Radiology. 1999;47- 75.

  4. Rockwood CA, Jr, Green DP, Bucholz RW. Fractures and dislocations of the wrist. In: Fractures in Adults. Lippincott Williams & Wilkins Publishers; 1996:745-867.

  5. Sochart DH, Birdsall PD, Paul AS. Perilunate fracture-dislocation: a continually missed injury. J Accid Emerg Med. May 1996;13(3):213-6. [Medline].

  6. Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic pitfalls in the ED: lunate and perilunate injuries. Am J Emerg Med. Mar 2001;19(2):157-62. [Medline].

  7. Kannikeswaran N, Sethuraman U. Lunate and perilunate dislocations. Pediatr Emerg Care. Dec 2010;26(12):921-4. [Medline].

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Dislocations, wrist. Lateral view of a lunate dislocation, with the classic teacup sign.
Dislocations, wrist. Anteroposterior (AP) view of a lunate dislocation.
 
 
 
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