Ankle Fracture in Emergency Medicine Medication
- Author: Kara Iskyan, MD; Chief Editor: Rick Kulkarni, MD more...
Medication Summary
Provide sufficient analgesia to patients sustaining an ankle fracture. A variety of medications can be used, ranging from oral acetaminophen to parenteral narcotics. For procedural sedation, agents include short-acting sedative-hypnotics and opiate analgesics, usually in combination. In addition, administer tetanus prophylaxis for open fractures.
Narcotic/analgesics
Class Summary
Pain control is essential to quality patient care as it ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Sedating properties of narcotics benefit patients who have sustained fractures.
Morphine sulfate (Duramorph, Astramorph, MS Contin)
Used to achieve a desired anxiolytic and analgesic effect because easily titrated to desired level of pain control or sedation. Reversed by naloxone.
Fentanyl citrate (Duragesic, Sublimaze)
Good choice for immediate pain relief and conscious sedation because of its rapid onset and short duration (30-60 min). Easily titrated to desired level of pain control or sedation. Easily reversed by naloxone.
Anxiolytic/hypnotics
Class Summary
Patients with painful injuries usually experience significant anxiety. Anxiolytics allow administration of a smaller analgesic dose to achieve the same effect.
Midazolam hydrochloride (Versed)
Short-acting benzodiazepine/sedative hypnotic used for its anxiolytic, amnestic, and sedating properties. Easily titrated and easily reversed with flumazenil.
Antidotes
Class Summary
In procedural sedation, a benzodiazepine antagonist may be needed to reverse the sedation and respiratory depression resulting from benzodiazepines and narcotics.
An opioid antagonist also can be used to reverse oversedation in a patient manifesting significant respiratory depression.
Flumazenil (Romazicon)
Selective antagonist of benzodiazepine receptor.
Naloxone (Narcan)
Prevents or reverses opioid effects including hypotension, respiratory depression, and sedation, possibly by displacing opiates from their receptor. Rapid onset of 1-2 min. Oversedation or respiratory depression should reverse rapidly.
Antibiotics
Class Summary
Therapy must cover all likely pathogens in the clinical setting.
Cefazolin (Ancef, Kefzol, Zolicef)
Cephalosporin that binds to 1 or more penicillin-binding proteins, arrests bacterial cell wall synthesis, and inhibits bacterial replication. Primarily active against skin flora, including Staphylococcus aureus.
Total daily dosages are the same for IV and IM routes.
Gentamicin (Gentacidin, Garamycin)
Aminoglycoside antibiotic used for gram-negative bacterial coverage. Commonly used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Used in conjunction with ampicillin or vancomycin for prophylaxis in patients with open fractures.
Vancomycin (Vancocin)
Potent antibiotic directed against gram-positive organisms and active against enterococcal species. Also useful in treatment of septicemia and skin structure infections. Used in conjunction with gentamicin for prophylaxis in patients with open fractures.
May need to adjust dose in patients with renal impairment.
Toxoids
Class Summary
These agents are used for tetanus immunization. A booster injection in previously immunized individuals is recommended to prevent this potentially lethal syndrome.
Tetanus toxoid adsorbed or fluid
Used to induce active immunity against tetanus in selected patients; tetanus and diphtheria toxoids are immunizing agents of choice for most adults and children >7 y; administer booster doses throughout life to maintain tetanus immunity; pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.
In children and adults, may administer into deltoid or midlateral thigh muscles. In infants, preferred site is midthigh laterally.
Immunoglobulins
Class Summary
Administer tetanus immune globulin to patients who may not have been immunized against Clostridium tetani products.
Tetanus immune globulin (TIG)
For passive immunization of persons with wounds that may be contaminated with tetanus spores.
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