What’s Your Diagnosis? Pain Management: Beyond Opioids
November 1, 2019
Posted by Andy Jagoda, MD in: What's Your Diagnosis , trackback
But before we begin, check out if you got last month’s case, on nonconvulsive status epilepticus, right. Click here to check out the answer!
Case Presentation: A 73-year-old woman in the ED after ?twisting? her ankle
A 73-year-old woman with a history of peptic ulcer disease and stage 3 chronic kidney disease presents to the ED after ?twisting? her ankle. She tried acetaminophen at home, but it didn?t adequately alleviate her pain. Currently, she complains of 6/10 pain at rest. She has mild swelling and tenderness at the posterior edge of her lateral malleolus. You order an ankle x-ray to evaluate for fracture and consider giving her oxycodone…
You wonder whether there is a better and safer alternative?
You concluded that your first patient likely had either an ankle sprain or a malleolar fracture, and that icing the area and immobilization was likely to improve her pain. With her comorbidities, you were concerned about using systemic NSAIDs, and you were concerned about giving her an opioid because of the association with adverse outcomes in older patients. You decided to apply ice, elevate the extremity, and order topical diclofenac. The radiograph was normal, and the patient?s pain improved with icing, immobilization with an air cast, and topical diclofenac. You discharged the patient with a prescription for topical diclofenac, a walker, and orthopedic follow-up.
Review the issue to find out more about the authors’ recommendation.
Not a subscriber? You can find out the conclusion and if you got it right, next month when a new case is posted, so stay tuned!