It won't be apparent, but I have been following this thread on holiday
ski-ing in New Hampshire. We had just got off the gondola today, and went
down a short steep link. There were a couple of snowboarders lying at the
bottom of the link, and one was obviously in pain. We stopped as I thought
he must have broken tib and fib since he was groaning as his friend released
his foot from the board. No, he had dislocated his left shoulder! Heigh ho,
I thought. So there at the bottom of the slope, with no towels or fentanyl
in sight, I popped it straight back in.
I'm here to say that if you do it soon after dislocation it is really quite
easy...
Best wishes
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 27 January 2006 05:47
To: [log in to unmask]
Subject: Re: Post reduction x-rays for anterior shoulder dislocation
----- Original Message -----
From: "Doc Holiday" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, January 27, 2006 2:29 AM
Subject: Re: Post reduction x-rays for anterior shoulder dislocation
> >Here's a hint. If you see a doctor either ask for a towel or take a
> >shoe
> >off, run a mile or offer to take over.
>
> --> Take a shoe off? Showing our age, aren't we? I often use my left
> --> hand
> or the patient's own weight with the key being taking the time to
> verbally
> (or hypnotically) promote relaxation.
Now, just because it's called Hippocratic doesn't mean you have to be over
two thousand years old to practice it! I think if you are going to practice
a traction method (and I rarely do these days) then you can't beat the
Hippocratic method. The foot rests not in the axilla but on the lateral
chest wall and merely provides robust countertraction that can't be emulated
by a third party (rather like the passengers in your car never seem to be
able to brace themselves properly for heavy braking or accelerating; you are
the only person who can anticipate and modulate the forces required). The
foot can also act as a fulcrum for the more resistant cases but it's
essentially a pure traction method so doesn't do much harm. I generally
reserve it for those patients who need a GA. Thankfully, Kocher's (original)
seems to work fine for most of my cases, under a modicum of analgesia rather
than sedation, usually fentanyl.
AF
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