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----- Original Message ----- From: "A S Lockey" Subject: Re: Flumazenil, Sedation and Fits > 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). Not strictly true Andy; even if you find a post-manipulation fracture, it's unlikely to be your fault if you practise atraumatic reduction. Don't get me started about defensive medicine...I do wish more of us could practice medicine in a style designed for our patients' benefit, not for our own! And while we're on the subject of working without x-rays, how many of you prefer to omit the post-reduction x-ray? I sometimes do for shoulders, and I rarely do post-reduction x-rays following small joint manipulations. Adrian Fogarty