Not all - those that tend to need sedation are those with associated avulsed
tuberosities or those who are already in irretrievable spasm. Once again, they
DO get analgesia - entonox. This allows subsequent sedation if required
without the tricky problem of loading up with morphine and then effectively
giving them an uncontrolled GA with the sedation. Entonox seems to be
underrated and underused (similar to regional nerve blocks). Also difficult to
use in the sedated patient, unless delivered through a system without demand
valve, i.e. a Boyles machine!!!!!! (or equivalent). Wow - can we link any more
threads into this one?
I would say (hand on precordium) that I get 8/10 shoulders back this way
without resorting to sedation (which I will freely give if necessary). I also
agree that these patients should be triaged straight to XRay and, in the
absence of Triage category 1 or 2 patients, should get the next available XRay
room. The pain from these injuries and the relief that can be obtained from a
swift reduction justifies a swift confirmatory XRay.
Andy
>===== Original Message From Accident and Emergency Academic List
<[log in to unmask]> =====
>I must confess I was hoping someone else would say
>they didnt know what the Belsher technique was before
>I had to.
>It turns out though Ive been doing this same technique
>for several years, using relaxation techniques I
>picked up doing a hypnosis course. I have never got
>above a 30-40% success rate though, unless extremely
>careful about 'patient selection'. Some of the
>problems in delay and x ray can be solved by walking
>the patient round to x ray from triage then doing the
>reduction in the x ray room. It certainly surprises
>the radiographer when you ask for a postreduction
>film.
>Do those of you advocating this, honestly, with your
>mits on your bits, get ALL your shoulders back this
>way, without analgesia? If so I must be crap at it -
>the problem I have is that even very slowly, it does
>hurt and some people it seems just can't relax
>whatever you do.
>
>Steve Meek
>Bath
>--- Adrian Fogarty <[log in to unmask]> wrote:
>> ----- Original Message -----
>> From: "Paul Ransom"
>> Subject: Re: Flumazenil, Sedation and Fits
>> > For those of us out of the country last year, or
>> having an off day during
>> > that posting, what exactly is the 'Belsham
>> technique'? I remain to be
>> > convinced about the analgesia free reduction.
>>
>> OK here goes, it's actually Kocher's original
>> technique described in the
>> late 19th century and Phil loves to show me the
>> original German transcript!
>>
>> Firstly, NO traction allowed.
>>
>> Hold the flexed elbow close to the patient's side
>> i.e. adducted with the
>> forearm pointing to the roof (supine patient).
>>
>> Then slowly externally rotate the humerus - this bit
>> takes ages - all the
>> while keeping that elbow close to the patient's
>> side.
>>
>> When the forearm reaches the horizontal position
>> (i.e. the humerus is now 90
>> degrees externally rotated), slowly flex the
>> humerus, keeping the forearm
>> externally rotated throughout.
>>
>> At full flexion of the humerus, you should now
>> internally rotate the arm,
>> and lo and behold the joint is back in!
>>
>> It's a bizarre experience, cos you can't really see
>> where or when the
>> reduction occurred. I think you need an intact
>> humeral head for it i.e. no
>> fractures allowed. Phil will let us know anything
>> I've missed out, I'm sure,
>> and he's got some neat pictures describing the
>> anatomical basis of the
>> technique. I'm not so patient so I sometimes use a
>> little sedation/analgesia
>> but I still like the technique itself - it's very
>> "drug sparing" so to
>> speak.
>>
>> Adrian Fogarty
>
>
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