Like other respondents, I too will put back a dislocated shoulder in a
patient with no history of trauma and recurrent dislocations without an
initial X-ray. The purists would probably say that if there were a fracture
on the post manipulation film then medico-legally you have no evidence that
you didn't cause it (unless you have an X-ray from a previous attendance
with it on of course).
The issue boils down to one of experience and risk management. Out of hours
in departments with no immediate shop-floor senior cover then we should be
advocating our juniors to avoid being cavalier and protect themselves (and
the patient) with an initial X-Ray. With the benefit of experience, those
who are more senior will view some of these patients as low risk of
associated injuries and minimise the discomfort of the dislocation by
manipulating it prior to X-Ray.
Andy
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of [log in to unmask]
Sent: 13 November 2001 21:22
To: [log in to unmask]
Subject: Flumazenil, Sedation and Fits
Rowley Cottingham wrote:
>> I'd agree with that statement. A recurrent anterior dislocation not
>> associated with trauma can be treated prior to X ray. Has anyone had a
>> problem doing this?
>>
>> Ray McGlone
>> A&E Lancaster
>I do. It sets something of a precedent. Not for me, you understand - I
>popped
one back the other day. However, I think I have told the tale of >the
Consultant
surgeon hauling on his son's shoulder convinced it was >dislocated and it
was
not. Whole heap of issues there, but essentially >if he couldn't diagnose
it
an SHO should not be allowed to treat without >X-ray.
>I know it smacks of do as I say not do as I do, but these guys need
>protection.
>Best wishes,
>Rowley Cottingham
I understand , but for the sake of the argument let me ask: what makes you
different
from a consultant surgeon? Experience, you might reply. Then, if one knows
how
to diagnose an anterior dislocation and there is no history of trauma, why
X-Ray?
OK, an inexperienced SHO who has, maybe, seen one or two dislocated
shoulders
might not be able to make that diagnosis (and could well be unable to
interpret
the X-Ray, too). In the majority of cases, though, there will be a senior
doctor
around who can quickly decide whether to X-Ray or not, saving the patient
time
(and minimizing the pain).
Post reduction, I always X-Ray.
Marcello della Corte
Staff Grade
Emergency Department
Oxford
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