----- Original Message -----
From: Dunn Matthew
> On opiates: anyone use fentanyl? Works well, wears off fast, patient feels
> good after.
Yes I use fentanyl and alfentanyl; you can achieve rapid deep
analgesia/sedation with these drugs with very quick recovery. Of course
these drugs are potent airway obstructors and apnoea inducing agents, but I
no longer consider airway obstruction or apnoea as a big problem as long as
you're prepared for it. After all, that's what planned general anaesthesia
is all about...
> I agree wih Philip Belsham- reduce slowly enough that you don't get a
clunk.
I can bear witness - Phil Belsham actually can reduce shoulders under fresh
air alone! I don't have that much patience however so I cheat - I use his
technique (Kocher's original, that is, but promoted by Phil), but slightly
speeded up by using my mixture of fentanyl and midazolam! Life would be dull
if we all did the same thing...
Adrian Fogarty
A&E Consultant
Royal Free Hospital
> Holding the patient's arm with the thumb and one finger of your hand
ensures
> you don't push them too hard (in elderly patients you can reduce without
any
> sedation- they are actually more comfortable during the procedure than
> before).
> On the subject of post reduction care- in my experience, the type of sling
> does not seem to make much difference; individual patient factors do (a
lot
> of young dislocators take the sling off and mobilise as soon as your back
is
> turned anyway). The big problem is that most of these patients will have
> damaged their rotator cuffs. These don't heal spontaneously- they should
at
> least be considered for repair. I've now moved to passing all my
dislocated
> shoulders onto an upper limb surgeon.
>
> Matt Dunn
>
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