13 - Analgesia for the Emergency Department Isolated Orthopedic Extremity Trauma Patient

Summary

SCOPE OF THE PROBLEM

Acute orthopedic injuries are among the most common conditions seen in the emergency department (ED). In 2004, fractures, sprains, strains, and contusions accounted for 14.3 million of the total 110.2 million ED visits in the United States. Acute orthopedic injuries typically cause acute pain and consequent guarding of the injured part by the patient in an effort to reduce the pain. Although this innate response prevents further injury, appropriate initial management of pain will allow more rapid mobilization and return to normal function. Conversely, uncontrolled pain may lead to adverse physiologic consequences such as prolonged immobilization increasing the risk of thromboembolic complications, limitation of range of motion, and muscular atrophy.

CLINICAL ASSESSMENT

The extent of acute orthopedic injury can often be predicted by the mechanism of injury. For example, a fall on an outstretched hand may indicate a Colle's, scaphoid, or radial head fracture; a twisting injury to the knee with an audible pop may indicate a rupture of the anterior cruciate ligament.

First and foremost in the examination of acute orthopedic injuries is a primary survey to detect potential life-threatening injuries. Then, a general assessment of the injured part by inspection, palpation, and range of motion should be performed to exclude immediate limb threats (e.g., a fracture dislocation of the ankle with vascular compromise) and to assess for deformity, limitation of range of motion, and overlying soft tissue injuries.