Consultant. No. 12
Optimal Strategies for Pain Control in Elderly Patients
By MICHELE IANNUZZI-SUCICH, MD | October 1, 2003
Modena Family Practice
Dr Iannuzzi-Sucich is a primary care physician and consultant in geriatrics at Modena Family Practice in Modena, NY. She is a graduate of the University of Connecticut Center on Aging geriatrics fellowship program in Farmington, Conn.
CASE 1: A 20-year-old woman sustains a fracture of the right femur during a car accident. She is taken by ambulance to the emergency department (ED). On arrival in the ED, she is given intravenous meperidine, which significantly relieves her pain. The patient subsequently undergoes surgical repair of the fractured femur and is discharged to rehabilitation after an uneventful hospital stay. CASE 2: A 75-year-old woman sustains a fracture of the right femur during a car accident. She is taken by ambulance to the ED. She has no significant medical history and is otherwise healthy. On arrival in the ED, she is given intravenous meperidine, which initially relieves her pain. After transfer to the medical-surgical floor, the patient experiences tremulousness, dysphoria, and myoclonus. Subsequently, she has a seizure. The injury and its treatment were identical in both cases. What went wrong in Case 2?
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