Pelvic Fracture in Emergency Medicine Medication

Updated: Oct 10, 2017
  • Author: Nicholas Moore, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication

Medication Summary

The primary treatment of pelvic fracture is for pain with narcotic analgesics.  Avoid nonsteroidal anti-inflammatory drugs until hemorrhage has been excluded, as it is the most common cause of mortality in pelvic fractures.

If open pelvic fracture is diagnosed or suspected, empiric antibiotics should be given within 6 hours to prevent osteomyelitis. Initial therapy should target gram-positive organisms with antibiotics such as cefazolin. [16]

If there is concern for associated perforation of bowel or vagina, broad-spectrum antibiotic coverage against gram-negative and anaerobic pathogens should be considered.

Patients with open pelvic fractures should also receive prophylaxis against tetanus. 

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Analgesics

Class Summary

Narcotic analgesics are the treatment of choice in the acute setting. 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 fractures. Adequate pain control helps keep the patient quiet and avoids movement of the pelvis.

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. Titrated doses especially useful in trauma patients to avoid oversedation or hypotension. Caution in hypotensive patients as may worsen hypotension because of histamine release. Consider fentanyl in this setting.

Fentanyl (Sublimaze, Duragesic)

Excellent drug for analgesia in patients with hypotension or whose cardiovascular condition is unstable. Does not release histamine. Short-acting acutely, duration becomes longer with repetitive dosing.

Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

DOC for treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs or those at high risk of bleeding, with upper GI disease, or taking oral anticoagulants. DOC for pain relief in noninflammatory conditions.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

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

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

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

Oxycodone and aspirin (Percodan, Roxiprin)

Drug combination indicated for relief of moderately severe to severe pain. Avoid in early treatment because of platelet inhibition from aspirin and increased risk of bleeding. See discussion under NSAIDs above.

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