Ankle Dislocation Management in the ED Medication

Updated: Jan 26, 2022
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication

Medication Summary

Drugs used to treat the pain associated with dislocations include analgesics and anxiolytics.

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Analgesics

Class Summary

Pain control is essential for 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 injuries.

Fentanyl citrate (Duragesic, Sublimaze)

Narcotic analgesic with greater potency and a much shorter half-life than morphine sulfate. This is the drug of choice (DOC) for conscious sedation analgesia. With short duration (30-60 min) and ease of titration, this is an excellent choice for pain management and sedation. It is easily and quickly reversed by naloxone. After the initial dose, subsequent doses should not be titrated more frequently than q3h or q6h.

Oxycodone and acetaminophen (Percocet)

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

Oxycodone and aspirin (Percodan)

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

Codeine/acetaminophen (Tylenol-3)

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

Morphine sulfate (MS Contin, MSIR)

DOC for analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Various IV doses are used; commonly titrated until desired effects are obtained.

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Anxiolytics

Class Summary

Patients with painful injuries usually experience significant anxiety. Anxiolytics allow the clinician to administer a smaller analgesic dose to achieve the same effect.

Diazepam (Valium)

Depresses all levels of the CNS, including the limbic and reticular formation, possibly by increasing the activity of GABA, a major inhibitory neurotransmitter. Individualize dosage and increase cautiously to avoid adverse effects.

Lorazepam (Ativan)

Sedative-hypnotic in benzodiazepine class that has a short onset of effect and a relatively long half-life. By increasing GABA, a major inhibitory neurotransmitter, it may depress all levels of the CNS, including the limbic and reticular formation. When a patient needs to be sedated for longer than 1 day, this medication is excellent. Monitor the patient's blood pressure after administering the dose, and adjust as necessary.

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