After the ED evaluation and treatment plan is executed, the effects of interventions must be considered when determining disposition. For example, it may be unsafe to allow a patient to drive himself home after administration of an opioid until after the clinical effects have resolved. In patients admitted for further care, this may be less of a concern, but cumulative effects of multiple doses may compound their effect, and management should be discussed with inpatient providers.
Often, painful traumatic conditions require ongoing analgesia. Providing patients with a means of achieving this should not be overlooked. Discharged patients may require a prescription for medication to take at home, and admitted patients may require continuing doses of analgesia.
When continuing medication upon disposition, the side-effect and medication interaction profile becomes more significant when compared to single doses given initially in the ED. The provider should be familiar with common concerns for routinely prescribed medications (eg, increased incidence of peptic ulcers and renal failure with NSAIDs; sedation, constipation, and nausea with opioids; or interactions with other medications like antiplatelet therapy or warfarin). As always, the likelihood of benefit from these medications must be compared to the potential for harm. The provider may be able to tailor a plan by making a reasonable estimate as to the duration of symptoms based on the injury and the ability to schedule a follow-up visit.