I bet they worked a treat.  Haematoma block for this type of patient is
wonderful in the right hands so don't blame the technique, learn to do it
properly.   Sedating 99yr olds is (IMHO) more of a problem.  How long will
even 1mg of Midazolam render her precariously obtunded?  And how do you know
with Midazolam when she is safe to leave alone?  Then Morphine on top!!!
Ketamine?  Bah!

> -----Original Message-----
> From: John Chambers [SMTP:[log in to unmask]]
> Sent: Thursday, December 09, 2004 11:31 PM
> To:   [log in to unmask]
> Subject:      Re: Bilateral Colles Fractures
>
> sorry a bit late on this one
> but we would have reduced them  under sedation 1 mg midazolam 2 mg
> morphine 20 mg ketamine would work a treat in this lady
> when she woke up would admit to the medical ward
> Bilateral haematoma blocks indeed, bet they did not work
>
> Johnc
>
>       -----Original Message-----
>       From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of John Ryan
>       Sent: Friday, December 10, 2004 12:24 PM
>       To: [log in to unmask]
>       Subject: Re: Bilateral Colles Fractures
>
>
>       Simon,
>
>       Surely you should not lose sight of the patient here at the expense
> of the 'disorder'.  Why does she need manipulation ?  WiIl she still be
> alive by the time they have healed. What is your aim ?  Surely at 99 it is
> to achive function and comfort. Yeah, maybe she is living alone
> independently, carrying all her own shopping home at 99 in sunny
> Bournemouth Simon but I supsect she already has some other support.
>
>       I am sure the suggested management here is ageist, but I am not so
> sure it is wrong, I guess it is just pragmatic.  Maybe the treatment might
> be diffreent for another age group
>
>       Is not the issue here : To cure sometimes, to relieve often, to
> comfort always ?
>
>       John Ryan
>
>
>
>
>               ----- Original Message -----
>               From: Bell, Simon <mailto:[log in to unmask]>
>               To: [log in to unmask]
> <mailto:[log in to unmask]>
>               Sent: Thursday, December 09, 2004 4:48 PM
>               Subject: Bilateral Colles Fractures
>
>               I would like to pose the following scenario :
>               99 yr old lady with a mechanical fall has bilateral colles
> #'s both requiring manipulation.
>               We as a department referred for admission and manipulation
> in theatre (not necessarily GA) under the orthopaedic team,  met great
> resistance at senior level who felt a bilateral haematoma block should be
> done in A+E.
>               In the end, the lady was admitted and had bilateral
> haematoma blocks in theatre....
>               It has caused a little unrest and the issues is still not
> resolved. we feel bilateral haematomas blocks are unsafe and the lady
> needs to come in anyway as she wont be able to mobilise......
>               I would be interested in hearing peoples opinion on safety
> of the procedure and effects on theatre time etc...
>               Thanks
>               S Bell
>
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