----- Original Message -----
From: "John Chambers"
Subject: Re: Say NO to drugs!
> I know the UK is on the other side of the world but I think this
pre-occupation by the Emergency Medicine fraternity there with reducing
painful dislocated shoulders without the use of readily available
analgesics and sedatives in a safe hospital environment is bordering on
the eccentric!!
> OK recurrent dislocations usually go back fairly easily but many of
these patients are also in severe pain
> We treat a lot of dislocated shoulders here and give lots of drugs for
which the patients are eternally grateful ... and always get the job
done.
> Using analgesia is not a sign of any deficiency in care ...surely
> Other side of the world but a different planet!!!
Yes, John, you are quite correct - common sense from the antipodes as usual!
Once again, to quote Phil Belsham, by all means give 'em analgesia on
arrival or en route to x-ray etc. But they shouldn't need anything over and
above this basic requirement. Most importantly of all, they shouldn't need
sedation for this technique, but there's no problem with analgesia.
Personally though, I "cheat" by giving potent short acting analgesia for the
reduction, i.e. fentanyl or alfentanyl. That way I get the job done quickly
without getting too friendly with the punters and their
cats/wives/girlfriends, but I also keep Phil smiling as technically I'm not
sedating! And the patients are "treated and streeted" in no time.
Adrian Fogarty (forever the pragmatist)
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