Wrist Fracture Management in the ED Medication

Updated: Mar 04, 2021
  • Author: Bryan C Hoynak, MD, FACEP, FAAEM; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication Summary

Drugs used to treat fractures include analgesics and anxiolytics. In addition, proper antibiotics must be administered for open fractures.



Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Most analgesics have sedating properties that benefit patients who have sustained traumatic injuries.

Propoxyphene products were withdrawn from the United States market on November 19th, 2010. The withdrawal was based on new data showing QT prolongation at therapeutic doses. For more information, see the FDA MedWatch safety information.

Fentanyl (Duragesic)

Short duration (30-60 min), ease of titration, and rapid and easy reversal by naloxone make this an excellent choice for pain management and sedation.

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.

Propoxyphene/acetaminophen (Darvocet N-100)

Propoxyphene was withdrawn from the US market. Drug combination indicated for treatment of mild to moderately severe pain.

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.



Class Summary

Patients with painful injuries usually experience significant anxiety. Anxiolytics allow a smaller analgesic dose to achieve the same effect.

Lorazepam (Ativan)

Sedative hypnotic in benzodiazepine class that has short onset of effect and relatively long half-life. By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation.

Alprazolam (Xanax)

Indicated for treatment of anxiety and management of panic attacks.

Midazolam (Versed)

DOC for acute sedation/anxiety as adjuvant for reduction of acute fracture/dislocations. Titratable effect and anterograde amnesia for 1-2 h make this an ideal agent. Onset of action within 2 min, and effective duration of action 30 min IV and 45 min IM.