Orbital Fracture Management in the ED Medication

Updated: Jan 07, 2022
  • Author: Thomas Widell, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication

Medication Summary

When airway control is needed, facilitate intubation using drugs for rapid sequence induction. A cricothyrotomy kit should be kept at the bedside in case problems should arise.

Use medication, including NSAIDs, narcotics, and local anesthetics, as appropriate for pain control.

Complete exam of the eye may require dilation of the pupil using mydriatic solutions.

Administer tetanus toxoid for open wounds if the patient is not current on vaccinations.

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Nonsteroidal anti-inflammatory drugs (NSAIDs)

Class Summary

These agents are used most commonly for relief of mild to moderately severe pain. Effects of NSAIDs in the treatment of pain tend to be patient specific, yet ibuprofen is usually the drug of choice (DOC) for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.

Ibuprofen (Ibuprin, Advil, Motrin)

Usually the DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of the enzyme cyclooxygenase, which inhibits prostaglandin synthesis.

Ketoprofen (Oruvail, Orudis, Actron)

Used for relief of mild to moderately severe pain and inflammation. Administer small dosages initially to patients with small bodies, older persons, and those with renal or liver disease. Doses higher than 75 mg do not increase therapeutic effects. Administer high doses with caution, and observe closely.

Naproxen (Anaprox, Naprelan, Naprosyn)

Used for relief of mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing activity of the enzyme cyclooxygenase, which decreases prostaglandin synthesis.

Flurbiprofen (Ansaid, Ocufen)

Provides analgesic, antipyretic, and anti-inflammatory effects. May inhibit the cyclooxygenase enzyme, inhibiting prostaglandin biosynthesis.

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Analgesics

Class Summary

Pain control is essential for providing quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties of benefit for patients with sustained fractures.

Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

DOC for treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs, or in those with upper GI disease or taking oral anticoagulants.

Acetaminophen and codeine (Tylenol #3)

Drug combination indicated for treatment of mild to moderately severe pain.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

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

Oxycodone and acetaminophen (Percocet)

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

Morphine sulfate (Duramorph, Astramorph, MS Contin)

DOC for narcotic analgesia due to its reliable and predictable effects, safety, and ease of reversibility with naloxone. Administer by IV route; may be dosed in a number of ways and commonly is titrated until desired effect is obtained.

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Tetanus toxoid

Class Summary

This agent is used for tetanus immunization. Booster injection in previously immunized individuals is recommended to prevent this potentially lethal syndrome.

Tetanus toxoid adsorbed or fluid

Used to induce active immunity against tetanus in selected patients. Tetanus and diphtheria toxoids are the immunizing DOCs for most adults and children >7 years. Booster doses are needed to maintain tetanus immunity throughout life.

Pregnant patients should receive only tetanus toxoid--not a diphtheria antigen-containing product.

For children and adults, tetanus toxoid may be administered into deltoid or midlateral thigh muscles. For infants, the preferred site of administration is midthigh lateral.

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Immunoglobulins

Class Summary

Patients who may not have been immunized against Clostridium tetani products should receive tetanus immune globulin.

Tetanus immune globulin (TIG)

Used for passive immunization of any person with a wound that may be contaminated with tetanus spores.

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