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Sun, 22 Dec 2002 09:28:46 -0000

Anne,

There are two problems which occur to me about suggestion 5 in the
pre-hospital field.

Firstly, we cannot convey the patient with the stretcher cot in the elevated
position. (Manufactures recommendations ref. centre of gravity in a moving
vehicle) This makes it impossible to achieve the height required.

Secondly if it was the right shoulder, on some ambulances, there is often
not enough room for the patient's arm between the cot and the side of the
vehicle.

I have, however, adopted this positioning for the patient on transferring
them to the hospital trolley and it does afford the patient additional pain
relief.

Merry Christmas to all on the list and a safe one for those of us working.

Jean Cragg MBE SR Para.
East Midlands Ambulance Service.

----- Original Message -----
From: "Anne Weaver" <aeweaver@bigfoot.com>
To: "TRAUMA" <trauma-list@trauma.org>
Sent: Wednesday, December 18, 2002 10:26 PM
Subject: Re: Dislocated shoulders

> Just a suggestion for any paramedics or PHC providers who are not
> comfortable with reducing dislocated shoulders or who cannot do so due to
> protocols. A technique which I use in the Emergency Dept prior to
> undertaking any active attempts at reduction is to ask the patient to lie
> prone on the stretcher / trolley with their injured arm hanging over the
> edge of the trolley. On many occasions this has resulted in spontaneous
> reduction of the dislocation after 10-20 minutes. This has several
benefits:
> 1. It is more comfortable for the patient once they have manoeuvred into
> position.
> 2. It allows gravity to assist with the reduction.
> 3. Muscle spasm decreases as they are in less pain.
> 4. It may avoid the need for "pulling" or sedative / analgesic drugs.
> 5. Patients can go home quicker. (after an xray)
> If this was done as a pre-hospital manoeuvre the shoulder might even be
back
> in joint on arrival at hospital!
> The patients are usually amazed and very grateful that such a simple trick
> works. It even works in big rugby players! Well worth a go!
>
> Anne Weaver
> Specialist Registrar in Emergency Medicine, Liverpool.
>
>
>
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Dislocated shoulders