List Archives

Thu, 30 May 2002 20:49:36 -0500

This is a multi-part message in MIME format.

------=_NextPart_000_0055_01C2081B.8317F600
Content-Type: text/plain;
	charset="us-ascii"
Content-Transfer-Encoding: 7bit

Gosh, I guess I am a beast. I never bother with analgesia, or much
discussion in advance. I usually reduce the "nursemaid's elbow" within
seconds of entering the patient's room. During the initial examination,
I reduce the elbow before the child or the parents even know what is
going on. I usually tell them, "OK, it should be back to normal in a few
minutes." I am met with surprise, and then I explain the condition.
Sometimes the child is using the arm before we are even done with the
discussion. Always within 10 minutes.

JM 

John L. Meade, MD, FACEP 

Emergency Medicine Specialist

Emerald Healthcare Group, P.A. 

 <http://www.statdoc.com/> http://www.statdoc.com/  

When you dream in color, it's a pigment of your imagination.

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of Barry Armstrong
Sent: Thursday, May 30, 2002 20:33
To: trauma-list@trauma.org
Subject: RE: Pediatric Injuries

Dave:

This condition is "pulled elbow", sometimes called "nursemaid's elbow"
in Britain.

In a 1-5 year old, pulling the child by one arm can cause  dislocation
of the radial head behind the annular ligament, at the elbow.  

I usually spend time, getting the parents confidence and understanding,
before attempting the reduction. The reduction is quite a painful
process, better with some analgesia.  The children usually cry out with
the reduction, but become normal toddlers within a few minutes.  

Since the average layperson (and many health care workers) are unaware
of the risks of lifting/swinging a toddler by one arm, we don't consider
this child abuse, rather it is bad luck.   The parents need to be
informed about the risk of recurrence.

For more information, try these
<http://www.google.com/search?sourceid=navclient&querytime=Fx2WjB&q=pull
ed+elbow> sites from Google.

For pictures and information about the reduction, see this
<http://www.rch.unimelb.edu.au/clinicalguide/pages/elbow.php> site.

My advice:  Splint the child's arm in a position of comfort, protect the
arm, consider acetaminophen and send to hospital for reduction within a
few hours.  The child should be able to return to the theme park that
afternoon.

Barry Armstrong

General Surgeon

Dryden, Ontario, Canada

-----Original Message-----
From: Dave Eging
Subject: Pediatric Injuries

Hello All,

I am new to this list and I thought I would take this opportunity to ask
a
question that I still have not gotten a straight answer for yet. I work
in a
Theme Park setting and I deal mostly with children, I have had instances
in
the past where a parent has brought in their child having pain after
lifting
them by the arm. The parents all claim that they heard or felt a "pop"
prior
to the child having pain in the affected extremity. I was wondering what
the
best course of treatment should be if you are presented with something
of
this nature. Given that the child is reluctant to let you touch or move
the
injured extremity, would your best course of action be to immobilize the
area completely and send them for and x-ray or try and determine the
range
of motion and then decide how you are going to splint? Another question
is
if it is in the elbow, do you splint the elbow in a straight position or
do
you splint it with a bend at the elbow and then put them in a sling? I
know
this may seem like something that is obvious but as I have said before I
never really have gotten a straight answer yet, thanks for any help you
can
give me.

Dave

------=_NextPart_000_0055_01C2081B.8317F600
Content-Type: text/html;
	charset="us-ascii"
Content-Transfer-Encoding: quoted-printable

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<html>

<head>
<META HTTP-EQUIV=3D"Content-Type" CONTENT=3D"text/html; =
charset=3Dus-ascii">

<meta name=3DGenerator content=3D"Microsoft Word 10 (filtered)">

<style>
<!--
 /* Font Definitions */
 @font-face
	{font-family:Tahoma;
	panose-1:2 11 6 4 3 5 4 4 2 4;}
 /* Style Definitions */
 p.MsoNormal, li.MsoNormal, div.MsoNormal
	{margin:0in;
	margin-bottom:.0001pt;
	font-size:12.0pt;
	font-family:Arial;}
a:link, span.MsoHyperlink
	{color:blue;
	text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
	{color:blue;
	text-decoration:underline;}
p.MsoPlainText, li.MsoPlainText, div.MsoPlainText
	{margin:0in;
	margin-bottom:.0001pt;
	font-size:10.0pt;
	font-family:"Courier New";}
p
	{margin-right:0in;
	margin-left:0in;
	font-size:12.0pt;
	font-family:Arial;}
span.EmailStyle18
	{font-family:Arial;
	color:navy;
	font-weight:normal;
	font-style:normal;
	text-decoration:none none;}
@page Section1
	{size:8.5in 11.0in;
	margin:1.0in 1.25in 1.0in 1.25in;}
div.Section1
	{page:Section1;}
-->
</style>

</head>

<body lang=3DEN-US link=3Dblue vlink=3Dblue>

<div class=3DSection1>

Gosh, I guess I am a beast. I never bother with =
analgesia,
or much discussion in advance. I usually reduce the =
&#8220;nursemaid&#8217;s
elbow&#8221; within seconds of entering the patient&#8217;s room. During =
the
initial examination, I reduce the elbow before the child or the parents =
even
know what is going on. I usually tell them, &#8220;OK, it should be back =
to
normal in a few minutes.&#8221; I am met with surprise, and then I =
explain the
condition. Sometimes the child is using the arm before we are even done =
with
the discussion. Always within 10 minutes.

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3DArial><span =
style=3D'font-size:
12.0pt;color:navy'>&nbsp;</span></font></p>

<div>

<p class=3DMsoPlainText><font size=3D3 color=3Dnavy face=3DArial><span
style=3D'font-size:12.0pt;font-family:Arial;color:navy'>JM =
</span></font></p>

<p class=3DMsoPlainText><font size=3D3 color=3Dnavy face=3DArial><span
style=3D'font-size:12.0pt;font-family:Arial;color:navy'>&nbsp; =
</span></font></p>

<p class=3DMsoPlainText><font size=3D3 color=3Dnavy face=3DArial><span
  =
style=3D'font-size:12.0pt;font-family:Arial;color:navy'>John</span></font=
><font
 size=3D3 color=3Dnavy face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial;
 color:navy'> </span></font><font size=3D3 color=3Dnavy =
face=3DArial><span
  =
style=3D'font-size:12.0pt;font-family:Arial;color:navy'>L.</span></font><=
font
 size=3D3 color=3Dnavy face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial;
 color:navy'> </span></font><font size=3D3 color=3Dnavy =
face=3DArial><span
  =
style=3D'font-size:12.0pt;font-family:Arial;color:navy'>Meade</span></fon=
t><font
 size=3D3 color=3Dnavy face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial;
 color:navy'>, </span></font><font size=3D3 color=3Dnavy =
face=3DArial><span
  =
style=3D'font-size:12.0pt;font-family:Arial;color:navy'>MD</span></font><=
font
size=3D3 color=3Dnavy face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial;
color:navy'>, FACEP </span></font></p>

<p class=3DMsoPlainText><i><font size=3D3 color=3Dgreen =
face=3DArial><span
style=3D'font-size:12.0pt;font-family:Arial;color:green;font-style:italic=
'>Emergency
Medicine Specialist</span></font></i></p>

<p class=3DMsoPlainText><font size=3D3 color=3Dnavy face=3DArial><span
style=3D'font-size:12.0pt;font-family:Arial;color:navy'>Emerald =
Healthcare Group,
P.A. </span></font></p>

<p class=3DMsoPlainText><font size=3D2 color=3Dnavy face=3D"Courier =
New"><span
style=3D'font-size:10.0pt;color:navy'><a =
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.statdoc.com/"><font
size=3D3 face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial'>http://www.statdoc.com/</spa=
n></font></a></span></font><font
size=3D3 color=3Dnavy face=3DArial><span =
style=3D'font-size:12.0pt;font-family:Arial;
color:navy'>&nbsp; </span></font></p>

<p class=3DMsoPlainText><font size=3D2 color=3Dnavy face=3D"Courier =
New"><span
style=3D'font-size:10.0pt;color:navy'>&nbsp;</span></font></p>

<p class=3DMsoPlainText><em><b><i><font size=3D2 color=3Dblack =
face=3D"Times New Roman"><span
style=3D'font-size:10.0pt;color:black;font-weight:bold'>When you dream =
in color,
it's a pigment of your =
imagination.</span></font></i></b></em><b><i><font
color=3Dblack face=3D"Times New Roman"><span style=3D'font-family:"Times =
New Roman";
color:black;font-weight:bold;font-style:italic'><br>
</span></font></i></b><font size=3D3 color=3Dblack face=3D"Times New =
Roman"><span
style=3D'font-size:12.0pt;font-family:"Times New =
Roman";color:black'><br>
<br>
</span></font></p>

<p class=3DMsoNormal><i><font size=3D3 color=3Dblack face=3DArial><span
style=3D'font-size:12.0pt;color:black;font-style:italic'><br>
</span></font></i><font color=3Dnavy><span style=3D'color:navy'><br>
&nbsp;</span></font></p>

</div>

<p class=3DMsoNormal><font size=3D3 color=3Dnavy face=3DArial><span =
style=3D'font-size:
12.0pt;color:navy'>&nbsp;</span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma'>-----Original =
Message-----<br>
<b><span style=3D'font-weight:bold'>From:</span></b> =
trauma-list-admin@trauma.org
[mailto:trauma-list-admin@trauma.org] <b><span =
style=3D'font-weight:bold'>On
Behalf Of </span></b></span></font><font size=3D2 face=3DTahoma><span
  style=3D'font-size:10.0pt;font-family:Tahoma'>Barry</span></font><font =
size=3D2
 face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'> =
</span></font><font
  size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'>Armstrong</span></font><fon=
t
size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'><br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> </span></font><font =
size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'>Thursday, May
 30, 2002</span></font><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
font-family:Tahoma'> </span></font><font size=3D2 face=3DTahoma><span
 style=3D'font-size:10.0pt;font-family:Tahoma'>20:33</span></font><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'><br>
<b><span style=3D'font-weight:bold'>To:</span></b> =
trauma-list@trauma.org<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> RE: Pediatric =
Injuries</span></font></p>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3DArial><span
style=3D'font-size:12.0pt'>&nbsp;</span></font></p>

Dave: 
 
This condition is &quot;pulled elbow&quot;, sometimes called =
&quot;nursemaid's
elbow&quot; in Britain. 
 
In a 1-5 year old, pulling the child by one arm can cause&nbsp; =
dislocation of
the radial head behind the annular ligament, at the elbow.&nbsp; 
 
I usually spend time, getting the parents confidence and understanding, =
before
attempting the reduction. The reduction is quite a painful process, =
better with
some analgesia.&nbsp; The children usually cry out with the reduction, =
but
become normal toddlers within a few minutes.&nbsp;&nbsp; 
 
Since the average layperson (and many health care workers) are unaware =
of the
risks of lifting/swinging a toddler by one arm, we don't consider this =
child
abuse, rather it is bad luck.&nbsp;&nbsp; The parents need to be =
informed about
the risk of recurrence.

<p style=3D'margin-left:.5in'><font size=3D2 face=3DArial><span =
style=3D'font-size:
10.0pt'><br>
For more information, try <a
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.google.com/search?sourceid=3Dnavclient&amp;querytime=3D=
Fx2WjB&amp;q=3Dpulled+elbow">these
sites from Google</a>.<br>
<br>
For pictures and information about the reduction, <a
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.rch.unimelb.edu.au/clinicalguide/pages/elbow.php">see =
this
site.</a><br>
<br>
My advice:&nbsp; Splint the child's arm in a position of comfort, =
protect the
arm, consider acetaminophen and send to hospital for reduction within a =
few
hours.&nbsp; The child should be able to return to the theme park that
afternoon.</span></font></p>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D3 =
face=3DArial><span
style=3D'font-size:12.0pt'>&nbsp;</span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DArial><span
  style=3D'font-size:10.0pt'>Barry</span></font><font size=3D2><span
 style=3D'font-size:10.0pt'> </span></font><font size=3D2><span =
style=3D'font-size:
  10.0pt'>Armstrong</span></font></p>

</div>

<div>

<p class=3DMsoNormal style=3D'margin-left:.5in'><font size=3D2 =
face=3DArial><span
style=3D'font-size:10.0pt'>General Surgeon</span></font></p>

</div>

<div>

<p class=3DMsoNormal =
style=3D'margin-right:0in;margin-bottom:12.0pt;margin-left:
.5in'><font size=3D2 face=3DArial><span =
style=3D'font-size:10.0pt'>Dryden</span></font><font
 size=3D2><span style=3D'font-size:10.0pt'>, </span></font><font =
size=3D2><span
  style=3D'font-size:10.0pt'>Ontario</span></font><font size=3D2><span
 style=3D'font-size:10.0pt'>, </span></font><font size=3D2><span =
style=3D'font-size:
  10.0pt'>Canada</span></font><font size=3D2><span =
style=3D'font-size:10.0pt'><br>
<br>
-----Original Message-----<br>
From: </span></font><font size=3D2><span =
style=3D'font-size:10.0pt'>Dave</span></font><font
 size=3D2><span style=3D'font-size:10.0pt'> </span></font><font =
size=3D2><span
  style=3D'font-size:10.0pt'>Eging</span></font><font size=3D2><span
style=3D'font-size:10.0pt'><br>
Subject: Pediatric Injuries<br>
<br>
<br>
Hello All,<br>
<br>
I am new to this list and I thought I would take this opportunity to ask =
a<br>
question that I still have not gotten a straight answer for yet. I work =
in a<br>
Theme Park setting and I deal mostly with children, I have had instances =
in<br>
the past where a parent has brought in their child having pain after =
lifting<br>
them by the arm. The parents all claim that they heard or felt a
&quot;pop&quot; prior<br>
to the child having pain in the affected extremity. I was wondering what =
the<br>
best course of treatment should be if you are presented with something =
of<br>
this nature. Given that the child is reluctant to let you touch or move =
the<br>
injured extremity, would your best course of action be to immobilize =
the<br>
area completely and send them for and x-ray or try and determine the =
range<br>
of motion and then decide how you are going to splint? Another question =
is<br>
if it is in the elbow, do you splint the elbow in a straight position or =
do<br>
you splint it with a bend at the elbow and then put them in a sling? I =
know<br>
this may seem like something that is obvious but as I have said before =
I<br>
never really have gotten a straight answer yet, thanks for any help you =
can<br>
give me.<br>
<br>
</span></font><font size=3D2><span =
style=3D'font-size:10.0pt'>Dave</span></font></p>

</div>

</div>

</body>

</html>

------=_NextPart_000_0055_01C2081B.8317F600--

List Archives

For your convenience, find the Trauma List Archive Below

Pediatric Injuries