Esophageal Rupture and Tears in Emergency Medicine Medication

Updated: Oct 13, 2016
  • Author: Ugo Anthony Ezenkwele, MD, MPH; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Medication

Medication Summary

Analgesia and antibiotics are required for management.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Many analgesics have sedating properties that are beneficial to patients who have sustained trauma.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

DOC for narcotic analgesia because of reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

IV doses may be administered in a number of ways, commonly titrated until desired effect is obtained.

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Antiemetics

Class Summary

Useful in treating symptomatic nausea and preventing further contamination of pleural space.

Prochlorperazine (Compazine)

An antidopaminergic drug that blocks postsynaptic mesolimbic dopamine receptors. Has an anticholinergic effect and can depress the reticular activating system. May be responsible for relieving nausea and vomiting.

Metoclopramide (Reglan)

Dopamine antagonist that stimulates acetylcholine release in the myenteric plexus. Acts centrally on chemoreceptor triggers in the floor of the fourth ventricle, which provides important antiemetic activity.

Ondansetron (Zofran, Zofran ODT, Zuplenz)

Selective 5-HT3-receptor antagonist that blocks serotonin both peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin), and complete body radiotherapy.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Imipenem and cilastatin (Primaxin)

Used for treatment of multiple organism infections in which other agents do not have wide spectrum coverage or are contraindicated because of their potential for toxicity.

Piperacillin and tazobactam sodium (Zosyn)

Semisynthetic extended-spectrum penicillin that inhibits bacterial cell wall synthesis by binding to specific PBPs; most effective of the antipseudomonal penicillins. Tazobactam increases piperacillin activity against S aureus, Klebsiella, Enterobacter, and Serratia species; (greatest increase in activity against B fragilis) but does not increase anti-P aeruginosa activity.

Intra-abdominal and pelvic infections: The main pathogens in the lower abdomen and pelvis are aerobic coliform gram-bacilli and B fragilis. Enterococci are permissive and opportunistic pathogens and do not require special coverage.

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