A patient with a traumatic brain injury is showing signs of having pain. What would be the medication of choice for this patient?
1. Propofol
2. Meperidine
3. Morphine sulfate
4. Fentanyl
3
Rationale 1: Propofol is a sedative–hypnotic anesthetic and not used for this patient.
Rationale 2: There is no evidence to support the use of meperidine for treating the pain associated with a traumatic brain injury.
Rationale 3: The patient with a head injury may experience significant pain either from the head injury or from other injuries incurred in the traumatic event. Morphine is most widely used because it has a high level of efficacy and safety yet is minimally sedating. If necessary for a neurologic assessment, it can be reversed with Narcan.
Rationale 4: Fentanyl is used cautiously because it results in a mild but definite increase in intracranial pressure.
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