Agree with this. However, I feel that these patients should be triaged
straight to the Xray room along with an entonox cylinder for immediate films
followed by swift reduction as the only guaranteed thing that will reduce
the pain effectively is putting the shoulder back. I also come across a lot
of patients who initially claim they will not tolerate anything except being
"knocked out" as the last time they had a dislocation, a junior SHO swung
around as if they were in a tag-team wrestling match. Calm explanation and
no swift movements win round most of these. But I agree, there are some
patients in whom you are never going to win and resorting to your sedative
of choice is the kindest and most effective way of getting the shoulder back
in joint. We just need to minimise this group to the ones that need it
rather than letting our juniors (or peers!) slug in unnecessary or dangerous
amounts of drugs they may or may not be familiar with.
Andy
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Paul Bailey
Sent: 30 October 2001 06:52
To: [log in to unmask]
Subject: Re: Flumazenil, Sedation and Fits
Hi all....
yes, we have all at some stage seen / done reduction techniques that
require little in the way of analgesia or sedation. But the simple fact
remains these patients:
present in severe pain
usually require an x-ray to confirm the diagnosis and to exclude occult #
This takes time
Titrated IV analgesia is most effective at quickly controlling their pain
Not all patients will tolerate analgesia / sedation free reduction
and finally
most reduction techniques have success rates of the order of 70-90% in
experienced hands.
So, there are *always* going to be patients who require sedation /
analgesia / amnesia. To simply write off the whole topic of in department
sedation on account of one technique for shoulder reduction is invalid.
Kind regards
Paul Bailey MB BS FACEM
Western Australia
> You don't need anything to reduce shoulders. I was taught a superb
technique by Adrian's mate Phil Belsham that
> needs no analgesia or sedation.
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
> http://www.emergencyunit.com
>
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