Elbow Dislocation Management in the ED Medication

Updated: Jan 27, 2022
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication

Medication Summary

Analgesics and anxiolytics are used to manage the pain associated with dislocation.

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Analgesics

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)

Narcotic analgesic with greater potency and a much shorter half-life than morphine sulfate. Drug of choice (DOC) for conscious sedation analgesia. With short duration (30-60 min) and ease of titration, an 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.

Morphine sulfate (MS Contin, MSIR)

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

Various IV doses are used and are 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)

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

Lorazepam (Ativan)

Sedative-hypnotic in benzodiazepine class with short onset of effect and relatively long half-life. By increasing activity of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation. Excellent medication when patient needs to be sedated for >1 day. Monitor patient's BP after administering dose, and adjust as necessary.

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