Hip Dislocation Management in the ED Medication

Updated: Jan 07, 2022
  • 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, the consultant, and the patient must decide on the most appropriate type and place for reduction: open versus closed and emergency department versus operating room.

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

In addition to airway protection and rescue, 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 and for those with significant associated fractures, central dislocation, or associated neurovascular injury.

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Analgesics

Class Summary

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

Morphine sulfate (Duramorph, MS Contin, MSIR)

Drug of choice (DOC) for analgesia because of reliable and predictable effects, good safety profile, and ease of reversibility with naloxone.

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

Fentanyl citrate (Duragesic, Sublimaze)

More potent narcotic analgesic with shorter half-life than morphine sulfate. Suitable for procedural sedation analgesia. Excellent choice for pain management and sedation; 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

These agents should be used 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; 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 while achieving the same effect.

Diazepam (Valium)

Increasing the activity of GABA, a major inhibitory neurotransmitter, depresses all levels of CNS, including limbic and reticular formation. Dose should be individualized and increased 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. Increasing the 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 longer than 24 hours.

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