How would you achieve adequate pain relief for this patient

Reference no: EM133271990

Case Study - An 81-year-old woman presents to the emergency department after slipping on the ice in her driveway. She reports right hip pain and an inability to bear weight. She has no prior history of hip pain and is ambulatory with the use of a cane. She lives with her husband and performs all activities of daily living independently. Her medical history includes mild senile dementia, hypertension, stable coronary artery disease, and a history of transient ischemic attack. She is currently on low-dose aspirin, clopidogrel, metoprolol, lisinopril, and pravastatin.

Physical examination of the right hip shows a positive log roll test and demonstrates pain with range of motion. The patient's right leg is flexed and shortened. The skin over the hip and thigh is intact with no abrasions, and the knee and ankle are non-tender, with pain-free range of motion. The leg is also neurovascularly intact with good sensation, capillary refill, and pulses in the foot. Radiographs demonstrate a displaced sub capital femoral neck fracture of the right hip.

The patient receives an ultrasound guided fascia iliacus regional nerve block in the emergency department for pain control and is admitted to the hospital for treatment of her hip fracture.

Preoperative traction is not used (per the AAOS guideline, "moderate evidence does not support routine use of preoperative traction for patients with a hip fracture"), but the patient is placed on bed rest with use of intermittent pneumatic compression devices.

Questions - Provide references

1. How would you achieve adequate pain relief for this patient and minimize risk of delirium?

2. The patient is evaluated by the medicine service to determine her risk for surgery. Based on the data presented, how would you rate this patient's risk for poor surgical outcomes?

3. Could this patient's use of aspirin and clopidogrel increase her risk of bleeding?

Reference no: EM133271990

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