Pelvic Fracture in Emergency Medicine Medication

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 12, 2010
 

Medication Summary

Primary treatment of pelvic fracture is for pain with narcotic analgesics. Administer antibiotics whenever disruption of bowel, vagina, or urinary tract is suspected. Since bleeding is the major life-threatening complication of pelvic fractures, avoid nonsteroidal anti-inflammatory drugs in initial treatment. They may be considered later if inflammation is a concern.

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Analgesics

Class Summary

Narcotic analgesics are the treatment of choice in the acute setting. 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 who have sustained fractures. Adequate pain control helps keep the patient quiet and avoids movement of the pelvis.

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Morphine sulfate (Duramorph, Astramorph, MS Contin)

 

DOC for narcotic analgesia because of its reliable and predictable effects, safety, and ease of reversibility with naloxone. Administered IV, may be dosed in a number of ways and commonly is titrated until desired effect obtained. Titrated doses especially useful in trauma patients to avoid oversedation or hypotension. Caution in hypotensive patients as may worsen hypotension because of histamine release. Consider fentanyl in this setting.

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Fentanyl (Sublimaze, Duragesic)

 

Excellent drug for analgesia in patients with hypotension or whose cardiovascular condition is unstable. Does not release histamine. Short-acting acutely, duration becomes longer with repetitive dosing.

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Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

 

DOC for treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs or those at high risk of bleeding, with upper GI disease, or taking oral anticoagulants. DOC for pain relief in noninflammatory conditions.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

 

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

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

 

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

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Oxycodone and aspirin (Percodan, Roxiprin)

 

Drug combination indicated for relief of moderately severe to severe pain. Avoid in early treatment because of platelet inhibition from aspirin and increased risk of bleeding. See discussion under NSAIDs above.

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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine 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 

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

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Anterior-posterior (AP) compression pelvic fracture.
Vertical shear (VS) fracture pattern.
Anteroposterior (AP) compression injury as seen on an AP radiograph of the pelvis. Characteristic features of an AP compression injury include symphyseal and sacroiliac joint diastasis. In this patient, the pubic symphysis and right sacroiliac joint are widened.
Windswept pelvis (lateral compression injury) as seen on a pelvic CT scan. The patient sustained a left lateral compression injury with internal rotation of the left hemipelvis and a characteristic sacral buckle fracture. Note the concomitant left sacroiliac joint diastasis. The lateral force vector continued across the pelvis to produce external rotation of the right hemipelvis and diastasis of the right sacroiliac joint. The combination of injuries resulted in a windswept pelvis.
 
 
 
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