Etomidate-facilitated hip reduction in the emergency department

Abstract

Joint dislocations are common presenting complaints in emergency departments (EDs). Dislocations of major joints, such as the shoulder, elbow, and hip, are often difficult to gently reduce because of the challenge in obtaining sufficient relaxation of large muscle groups. This is the first reported use of etomidate to assist in the reduction of a major joint in an outpatient setting. We discuss the case of an elderly woman with total hip arthroplasty who experienced four spontaneous posterior hip dislocations in a 5-month period. Narcotics and benzodiazepines failed to facilitate reduction at every encounter, whereas etomidate made the procedure easy the two times it was used in the ED. This article reviews the administration of etomidate for conscious sedation and discusses potential complications.