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Wrist Fracture in Emergency Medicine Medication

  • Author: Bryan C Hoynak, MD, FACEP, FAAEM; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Feb 14, 2015
 

Medication Summary

Drugs used to treat fractures include analgesics and anxiolytics. In addition, proper antibiotics must be administered for open fractures.

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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. Most analgesics have sedating properties that benefit patients who have sustained traumatic injuries.

Propoxyphene products were withdrawn from the United States market on November 19th, 2010. The withdrawal was based on new data showing QT prolongation at therapeutic doses. For more information, see the FDA MedWatch safety information.

Fentanyl (Duragesic)

 

Short duration (30-60 min), ease of titration, and rapid and easy reversal by naloxone make this an excellent choice for pain management and sedation.

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.

Propoxyphene/acetaminophen (Darvocet N-100)

 

Propoxyphene was withdrawn from the US market. Drug combination indicated for treatment of mild to moderately severe pain.

Acetaminophen and codeine (Tylenol #3)

 

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

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

 

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 a smaller analgesic dose to achieve the same effect.

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.

Alprazolam (Xanax)

 

Indicated for treatment of anxiety and management of panic attacks.

Midazolam (Versed)

 

DOC for acute sedation/anxiety as adjuvant for reduction of acute fracture/dislocations. Titratable effect and anterograde amnesia for 1-2 h make this an ideal agent. Onset of action within 2 min, and effective duration of action 30 min IV and 45 min IM.

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Contributor Information and Disclosures
Author

Bryan C Hoynak, MD, FACEP, FAAEM Associate Clinical Professor of Emergency Medicine, University of California at Irvine School of Medicine; Director of Emergency Services, Chairman of Division of Emergency Medicine, Placentia-Linda Hospital

Bryan C Hoynak, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Burn Association, American College of Surgeons, American Heart Association, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Laura Hopson, MD Staff Physician, Department of Emergency Medicine, University of Michigan

Laura Hopson, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

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.

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Lateral radiograph of the wrist illustrating volar dislocation of the lunate.
During a soccer game, a 12-year-old boy fractured his wrist when falling on an outstretched hand. The fracture was reduced with traction and splinting under moderate sedation. Good postreduction alignment was achieved.
 
 
 
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