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Mon, 3 Jun 2002 09:30:32 -0400

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John,

I noticed the docs on the list all took care of this injury quickly and
effectively but with techniques that are not likely to be available to Dave.
Of course Dave might be a doctor, in which case all your advice is good and
right now I look like an idiot.

Hoping I am not
Tom

Thomas W. Connell II
President
Special Rescue Services.Inc

  -----Original Message-----
  From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]On
Behalf Of John L. Meade
  Sent: Thursday, May 30, 2002 9:50 PM
  To: trauma-list@trauma.org
  Subject: RE: Pediatric Injuries

  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/

  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 sites from Google.

  For pictures and information about the reduction, see this 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

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<BODY lang=3DEN-US vLink=3Dblue link=3Dblue>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D850432713-03062002>John,</SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D850432713-03062002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN =
class=3D850432713-03062002>I=20
noticed the docs on the list all took care of this injury quickly and=20
effectively but with techniques that are not likely to be available to=20
Dave.&nbsp; Of course Dave might be a doctor, in which case all your =
advice is=20
good and right now I look like an idiot.</SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D850432713-03062002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN =
class=3D850432713-03062002>Hoping=20
I am not </SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D850432713-03062002>Tom</SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D850432713-03062002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN =
class=3D850432713-03062002>
<DIV><FONT face=3DGaramond><STRONG>Thomas W. Connell =
II</STRONG></FONT></DIV>
<DIV><FONT face=3DGaramond><STRONG>President</STRONG></FONT></DIV>
<DIV><FONT face=3DGaramond><STRONG>Special Rescue=20
Services.Inc</STRONG></FONT></DIV></SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D850432713-03062002></SPAN></FONT>&nbsp;</DIV>
<BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px">
  <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT =
face=3DTahoma=20
  size=3D2>-----Original Message-----<BR><B>From:</B> =
trauma-list-admin@trauma.org=20
  [mailto:trauma-list-admin@trauma.org]<B>On Behalf Of </B>John L.=20
  Meade<BR><B>Sent:</B> Thursday, May 30, 2002 9:50 PM<BR><B>To:</B>=20
  trauma-list@trauma.org<BR><B>Subject:</B> RE: Pediatric=20
  Injuries<BR><BR></FONT></DIV>
  <DIV class=3DSection1>
  <P class=3DMsoNormal><FONT face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy">Gosh, I guess I am a beast. I =
never=20
  bother with analgesia, or much discussion in advance. I usually reduce =
the=20
  =93nursemaid=92s elbow=94 within seconds of entering the patient=92s =
room. During the=20
  initial examination, I reduce the elbow before the child or the =
parents even=20
  know what is going on. I usually tell them, =93OK, it should be back =
to normal=20
  in a few minutes.=94 I am met with surprise, and then I explain the =
condition.=20
  Sometimes the child is using the arm before we are even done with the=20
  discussion. Always within 10 minutes.</SPAN></FONT></P>
  <P class=3DMsoNormal><FONT face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy"></SPAN></FONT>&nbsp;</P>
  <DIV>
  <P class=3DMsoPlainText><FONT face=3DArial color=3Dnavy size=3D3><SPAN =

  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial">JM =
</SPAN></FONT></P>
  <P class=3DMsoPlainText><FONT face=3DArial color=3Dnavy size=3D3><SPAN =

  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial">&nbsp;=20
  </SPAN></FONT></P>
  <P class=3DMsoPlainText><FONT face=3DArial color=3Dnavy size=3D3><SPAN =

  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: =
Arial">John</SPAN></FONT><FONT=20
  face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial"> =
</SPAN></FONT><FONT=20
  face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: =
Arial">L.</SPAN></FONT><FONT=20
  face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial"> =
</SPAN></FONT><FONT=20
  face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: =
Arial">Meade</SPAN></FONT><FONT=20
  face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial">, =
</SPAN></FONT><FONT=20
  face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: =
Arial">MD</SPAN></FONT><FONT=20
  face=3DArial color=3Dnavy size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial">, FACEP=20
  </SPAN></FONT></P>
  <P class=3DMsoPlainText><I><FONT face=3DArial color=3Dgreen =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: green; FONT-STYLE: italic; =
FONT-FAMILY: Arial">Emergency=20
  Medicine Specialist</SPAN></FONT></I></P>
  <P class=3DMsoPlainText><FONT face=3DArial color=3Dnavy size=3D3><SPAN =

style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial">Emerald =
Healthcare=20
 Group, P.A. 
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; 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=20
 face=3DArial size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; FONT-FAMILY: =
Arial">http://www.statdoc.com/</A><FONT=20
 face=3DArial color=3Dnavy size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: navy; FONT-FAMILY: Arial">&nbsp;=20
 
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy">&nbsp;
 When you=20
 dream in color, it's a pigment of your=20
 imagination.<SPAN=20
 style=3D"FONT-WEIGHT: bold; COLOR: black; FONT-STYLE: italic; =
FONT-FAMILY: 'Times New Roman'"> <FONT=20
 face=3D"Times New Roman" color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: 'Times New =
Roman'"> 
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-STYLE: =
italic"> <FONT=20
 color=3Dnavy> &nbsp;</DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: navy">&nbsp;
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Tahoma">-----Original=20
 Message----- From:=20
 trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] =
<SPAN=20
 style=3D"FONT-WEIGHT: bold">On Behalf Of =
<FONT=20
 face=3DTahoma size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: =
Tahoma">Barry<FONT=20
 face=3DTahoma size=3D2>=20
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: =
Tahoma">Armstrong<FONT=20
 face=3DTahoma size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Tahoma"> <SPAN=20
 style=3D"FONT-WEIGHT: bold">Sent: Thursday, May 30,=20
 2002<SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Tahoma"> <SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: =
Tahoma">20:33<FONT=20
 face=3DTahoma size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Tahoma"> <SPAN=20
 style=3D"FONT-WEIGHT: bold">To: =
trauma-list@trauma.org <SPAN=20
 style=3D"FONT-WEIGHT: bold">Subject: RE: Pediatric=20
 Injuries
 <SPAN=20
 style=3D"FONT-SIZE: 12pt">&nbsp;
 <SPAN=20
 style=3D"FONT-SIZE: 10pt">Dave<SPAN=20
 style=3D"FONT-SIZE: 10pt">: This condition is "pulled elbow", =
sometimes=20
 called "nursemaid's elbow" in <SPAN=20
 style=3D"FONT-SIZE: 10pt">Britain<SPAN=20
 style=3D"FONT-SIZE: 10pt">. In a 1-5 year old, pulling the =
child by one=20
 arm can cause&nbsp; dislocation of the radial head behind the annular=20
 ligament, at the elbow.&nbsp; I usually spend time, getting =
the=20
 parents confidence and understanding, before attempting the reduction. =
The=20
 reduction is quite a painful process, better with some =
analgesia.&nbsp; The=20
 children usually cry out with the reduction, but become normal =
toddlers within=20
 a few minutes.&nbsp;&nbsp; Since the average layperson (and =
many health=20
 care workers) are unaware of the risks of lifting/swinging a toddler =
by one=20
 arm, we don't consider this child abuse, rather it is bad =
luck.&nbsp;&nbsp;=20
 The parents need to be informed about the risk of=20
recurrence.
 <SPAN=20
 style=3D"FONT-SIZE: 10pt"> For more information, try <A=20
 =
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=20
 sites from Google</A>. For pictures and information about the=20
 reduction, <A=20
 =
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=20
 site.</A> My advice:&nbsp; Splint the child's arm in a position =
of=20
 comfort, protect the arm, consider acetaminophen and send to hospital =
for=20
 reduction within a few hours.&nbsp; The child should be able to return =
to the=20
 theme park that afternoon.
 <DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 12pt">&nbsp;</DIV>
 <DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt">Barry<SPAN=20
 style=3D"FONT-SIZE: 10pt"> <SPAN=20
 style=3D"FONT-SIZE: 10pt">Armstrong</DIV>
 <DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt">General Surgeon</DIV>
 <DIV>
 <FONT=20
 face=3DArial size=3D2>Dryden<FONT=20
 size=3D2>, <SPAN=20
 style=3D"FONT-SIZE: 10pt">Ontario<SPAN=20
 style=3D"FONT-SIZE: 10pt">, <SPAN=20
 style=3D"FONT-SIZE: 10pt">Canada<SPAN=20
 style=3D"FONT-SIZE: 10pt"> -----Original Message----- From:=20
 <SPAN=20
 style=3D"FONT-SIZE: 10pt">Dave<SPAN=20
 style=3D"FONT-SIZE: 10pt"> <SPAN=20
 style=3D"FONT-SIZE: 10pt">Eging<SPAN=20
 style=3D"FONT-SIZE: 10pt"> Subject: Pediatric =
Injuries Hello=20
 All, I am new to this list and I thought I would take this =
opportunity=20
 to ask a question that I still have not gotten a straight answer =
for yet. I=20
 work in a Theme Park setting and I deal mostly with children, I =
have had=20
 instances in the past where a parent has brought in their child =
having pain=20
 after lifting them by the arm. The parents all claim that they =
heard or=20
 felt a "pop" prior to the child having pain in the affected =
extremity. I=20
 was wondering what the best course of treatment should be if you =
are=20
 presented with something of this nature. Given that the child is =
reluctant=20
 to let you touch or move the injured extremity, would your best =
course of=20
 action be to immobilize the area completely and send them for and =
x-ray or=20
 try and determine the range of motion and then decide how you are =
going to=20
 splint? Another question is if it is in the elbow, do you splint =
the elbow=20
 in a straight position or do you splint it with a bend at the elbow =
and=20
 then put them in a sling? I know this may seem like something that =
is=20
 obvious but as I have said before I never really have gotten a =
straight=20
 answer yet, thanks for any help you can give =
me. <FONT=20
 size=3D2><SPAN=20
style=3D"FONT-SIZE: =
10pt">Dave</DIV></DIV></BLOCKQUOTE></BODY></HTML>

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