Prehospital use of analgesia for suspected extremity fractures.

INTRODUCTION: Pain and its control have been studied extensively in the emergency department. Numerous studies indicate that inadequate treatment of pain is common, despite the availability of myriad analgesics. It has been suggested that oligoanesthesia is also a common practice in the prehospital setting. OBJECTIVE: To assess the use of prehospital analgesia in patients with suspected extremity fracture. METHODS: Emergency medical services (EMS) call reports were reviewed for all patients with suspected extremity fractures treated from June 1997 to July 1998 in a midwestern community with a population base of 223,000. Data collected included demographic information, mechanism of injury, medications given, and field treatment. Standing orders for administration of analgesia were available and permitted paramedics to give either morphine sulfate or nitrous oxide per protocol. RESULTS: The EMS call reports were analyzed for 1,073 patients with suspected extremity fractures. The mean patient age was 47 years. Accidental injuries comprised 86.5% of those reviewed. Suspected leg fractures were most common (20%), followed by hips (18%), arms (11%), knees (10%), ankles (9%), shoulders (7.2%), hands (5.5%), and wrists (5.3%). Multiple trauma and assorted broken digits accounted for the remaining 14%. The most common mechanisms of injury were: fall (43%), motor vehicle collision (21%), and human assault (10%). Intravenous lines were placed in 9.4% of patients; 17% received ice packs; 16% received bandage/dressings; 25% received air splints; and 19% were fully immobilized. Analgesia was administered to 18 patients (1.8%): 16 patients received nitrous oxide and two received morphine. CONCLUSION: Administration of analgesics to prehospital patients with suspected fractures was rare. Prehospital identification and treatment of pain for patients with musculoskeletal trauma could be improved.

Priapism in sickle cell disease.

An 18-year-old black man with known history of homozygous (SS) sickle cell disease presented with sudden onset of priapism awakening him from sleep. Priapism as an isolated manifestation, without other signs or symptoms of sickle cell crisis, is thought to be more prevalent than previously reported. The patient was taken to surgery, where 14-gauge intercaths were used to aspirate blood from his corpora cavernosa bilaterally. Complete detumescence was achieved. At a five-month follow-up visit, normal erectile capacity was reported.