A 21-year-old unrestrained driver with a past medical...

A 21-year-old unrestrained driver with a past medical history significant for asthma was involved in a single-vehicle automobile accident and has severe pain from an open fracture of his left tibia and fractured ribs. He is hypotensive with an initial blood pressure of $80 / 50 \mathrm{mmHg}$. The patient is currently receiving a liter bolus of lactated Ringer's solution. Which of the following analgesic agents is a reasonable choice in this setting of hypotension? (A) Meperidine $50 \mathrm{mg}$ intravenously. (B) Morphine $10 \mathrm{mg}$ intravenously. (C) Fentanyl $100 \mathrm{mcg}$ intravenously. (D) Propofol $50 \mathrm{mg}$ intravenously.

A 21-year-old unrestrained driver with a past medical history significant for asthma was involved in a single-vehicle automobile accident and has severe pain from an open fracture of his left tibia and fractured ribs. He is hypotensive with an initial blood pressure of $80 / 50 \mathrm{mmHg}$. The patient is currently receiving a liter bolus of lactated Ringer's solution. Which of the following analgesic agents is a reasonable choice in this setting of hypotension?
(A) Meperidine $50 \mathrm{mg}$ intravenously.
(B) Morphine $10 \mathrm{mg}$ intravenously.
(C) Fentanyl $100 \mathrm{mcg}$ intravenously.
(D) Propofol $50 \mathrm{mg}$ intravenously.

Labs

Want to see this concept in action?

NEW

Explore this concept interactively to see how it behaves as you change inputs.

View Labs

Key Concepts

Opioid Analgesics

Opioid analgesics are commonly used for pain management in trauma due to their potent analgesic properties. However, not all opioids have the same impact on hemodynamics; some may lead to histamine release or other effects that lower blood pressure. Therefore, in hypotensive patients, it is crucial to select an opioid that minimizes these adverse cardiovascular effects while still providing adequate pain control.

Fentanyl

Fentanyl is a synthetic opioid known for its rapid onset and short duration of action. It has minimal effects on blood pressure because it does not cause significant histamine release, making it a preferred option for analgesia in patients with hypotension. Its hemodynamic stability allows for effective pain management without further compromising circulatory status in a trauma setting.

Hemodynamic Effects of Analgesics

Many analgesic agents have significant effects on the cardiovascular system, which is particularly important in the management of trauma patients who may be hypotensive. Some medications can cause vasodilation or depress myocardial function, leading to further reductions in blood pressure. Choosing an analgesic in a hypotensive patient involves selecting one that provides effective pain relief without exacerbating circulatory instability.

Please give Ace some feedback