Case 4

A 25-year-old male has presented to the ED having performed a charity parachute jump. He landed awkwardly and has sustained an open fracture dislocation of his right ankle. He is still wearing sturdy leather boots.

He has no medical problems or allergies but had two bacon rolls and a cup of coffee while waiting for his flight to take off, 90 minutes ago.

He has a cool foot with a capillary refill time of 6 seconds and diminished gross sensation.

Which answer best describes the most appropriate immediate management?

You have administered 20 mg of intravenous morphine and he is still complaining of severe pain; it is 45 minutes since he injured his ankle and he still has his boot on.

Name two sedative agents that have a significant analgesic action.

You have decided to perform procedural sedation. Another doctor is present to perform the manipulation of the ankle fracture and the patient has verbally given consent for the procedure. The nurse asks what monitoring you would require.

List the minimum monitoring requirements during procedural sedation.

You consider which sedative agent to use.