Hip Dislocation in Emergency Medicine Medication

Updated: Apr 11, 2016
  • Author: Stephen R McMillan, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Medication

Medication Summary

Administer adequate parenteral analgesia. The emergency physician, consultant, and patient must decide on the most appropriate type and place for reduction: open versus closed and emergency department versus operating room.

If a closed reduction is attempted in the ED, the patient requires procedural sedation. Procedural sedation policies should be established to define who can administer medication, who must monitor the patient, the classes and doses of procedural sedation medications, and the resources on hand for resuscitation.

In addition to airway protection and rescue, the procedural sedation goals must include pain relief, muscle relaxation, and procedure amnesia.

General anesthesia in the operating room may be required for patients with dislocations that are irreducible by closed means as well as for those with significant associated fractures, central dislocations, or associated neurovascular injury.

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Analgesics

Class Summary

Pain control is essential to good-quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. The analgesic must have a rapid onset, predictable action, and be easily titratable.

Morphine sulfate (Duramorph, MS Contin, MSIR)

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

Various IV doses are used; commonly titrated until desired effect obtained.

Fentanyl citrate (Duragesic, Sublimaze)

More potent narcotic analgesic with shorter half-life than that of morphine sulfate. Suitable for procedural sedation analgesia. Excellent choice for pain management and sedation; has short duration (30-60 min) and easy to titrate. Easily and quickly reversed by naloxone.

Meperidine (Demerol)

Narcotic analgesic with multiple actions similar to those of morphine. May produce less constipation, smooth muscle spasm, and depression of cough reflex than similar analgesic doses of morphine.

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Sedative hypnotics

Class Summary

Use these agents for procedural sedation with rapid onset and short duration.

Propofol (Diprivan)

Phenolic compound; sedative hypnotic agent used for induction and maintenance of anesthesia or sedation; has anticonvulsant properties.

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Anxiolytics

Class Summary

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

Diazepam (Valium)

By increasing activity of GABA, major inhibitory neurotransmitter, depresses all levels of CNS including limbic and reticular formation. Individualize dose and increase it cautiously to avoid adverse effects.

Lorazepam (Ativan)

Sedative hypnotic in benzodiazepine class that has short onset of effect and relatively long half-life. By increasing activity of GABA, major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation. Excellent medication when patient needs to be sedated for >24 h.

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