IV Acetaminophen as Adjuvant Analgesic to Hydromorphone - Emergency Department Patients

Exclusion Criteria

• •Use of opioids or tramadol within past 24 hours.
• •Use of acetaminophen or non-steroidal anti-inflammatory medication within the previous 8 hours.
• •Prior adverse reaction to opioids or acetaminophen.
• •Chronic pain syndrome: frequently recurrent or daily pain for at least 3 months; examples of chronic pain syndromes include sickle cell anemia, osteoarthritis, fibromyalgia, and peripheral neuropathies.
• •Medical condition that might affect metabolism or opioid analgesics or acetaminophen such as hepatitis, renal insufficiency or failure, hypo- or hyper-thyroidism, Addison's or Cushing's disease
• •Pregnant or breastfeeding
• •Alcohol intoxication: the presence of alcohol intoxication as judged by the treating physician or nurse
• •Not at risk of suicide assessed by triage nurse
• •Systolic blood pressure \<100 mmHg
• •Heart Rate \< 60/min
• •Oxygen saturation \< 95% on room air:
• •Use of monoamine oxidase (MAO) inhibitors in past 30 days
• •Use of transdermal pain patches
• •Taking any medication that might interact with one of the study medications, such as a selective serotonin reuptake inhibitor (SSRI) or tricyclic anti-depressants, antipsychotics, anti-malarial medications (quinidine or halofantrine), amiodarone or dronedarone, diphenhydramine, celecoxib, ranitidine, cimetidine, ritonavir, terbinafine or St. John's Wort.
• •Patients who have been previously enrolled in this same study