Foot Dislocation Management in the ED Medication

Updated: Feb 09, 2022
  • Author: Christopher M McStay, MD, FAWM, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication Summary

Administer analgesia as appropriate. Ensure adequate coverage against tetanus. If dislocation is compound, broad-spectrum intravenous antibiotics are required. Generally, a cephalosporin is the drug of choice. Dirty wounds may need the addition of an aminoglycoside to target gram-negative organisms. Injuries heavily contaminated with soil or farmyard waste require penicillin to protect against Clostridium perfringens.



Class Summary

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 injuries.

Fentanyl citrate (Duragesic, Sublimaze)

More potent narcotic analgesic with a much shorter half-life than morphine sulfate. Drug of choice (DOC) for conscious sedation analgesia.

With short duration (30-60 min) and easy titration, excellent choice for pain management and sedation. Easily and quickly reversed by naloxone.

After 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.

Oxycodone and aspirin (Percodan)

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

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

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



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.

Midazolam (Versed)

DOC for procedural sedation to aid in reduction of anxiety associated with fractures or dislocations. Provides antegrade amnesia. Dose q1-2h.



Class Summary

Procedural sedation for reductions may require a sedative-hypnotic.

Propofol (Diprivan)

Phenolic compound. Sedative-hypnotic agent used for induction and maintenance of sedation or anesthesia.



Class Summary

Prophylaxis is given to patients with compound dislocations.

Cefazolin (Ancef, Kefzol, Zolicef)

First-generation semisynthetic 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 compound dislocations. Dosing regimens numerous and adjusted based on CrCl and changes in volume of distribution. May be given IV or IM.

Vancomycin (Vancocin)

Potent antibiotic directed against gram-positive organisms and active against enterococcal species. Used to treat septicemia and skin structure infections. Used in conjunction with gentamicin for prophylaxis in patients with penicillin allergy with compound dislocations. Dosage may need adjustment for patients with renal impairment.

Ampicillin (Omnipen, Marcillin)

Used along with gentamicin for prophylaxis in patients with compound dislocations. Interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Given in place of amoxicillin to patients unable to take PO medication.

Penicillin G (Pfizerpen)

Interferes with synthesis of cell wall mucopeptide during active replication, resulting in bactericidal activity against susceptible microorganisms.