Welcome to this week’s edition of Wednesday Wrap-up!
We had a great conference day including a great discussion on how to deal with anterior shoulder dislocations. Dr. Melton presented an EBM review of the literature comparing intra-articular lidocaine to procedural sedation for reducing shoulders. The evidence suggests that there is no significant difference between the two when it comes to the primary endpoint of successful reduction. However, the controversy is really over complications which the existing literature is quite weak in addressing as none seem to include adequate longterm follow up. I think the concluding remarks of the discussion were very important which is that we need to be familiar with multiple techniques for both the reduction and for providing analgesia and possibly sedation for this scenario. Dr. Cioe mentioned a great website for learning these various techniques created by two ED doc’s from Australia so check it out: shoulderdislocation.net
Would love to here everybody’s thoughts on their approach. What’s your agent of choice when it comes to analgesia and/or sedation and what’s your go-to technique for reduction? Leave your thoughts below.
Thanks for reading,
JK
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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2 Comments
Ian deSouza · February 6, 2013 at 6:03 pm
Ask the patient what they prefer! If presented with the option of injection/morphine IM versus time/nursing contraints associated with sedation, they often choose injection – at least an attempt…
mritchie · February 12, 2013 at 10:24 am
I would like to throw in my 2 cents and give another first option being some basic pain medication and the Stimson Method. I have used this technique on my last 3 shoulder dislocation patients. They were all younger with dislocation times between 1-8 hours. If they are cooperative and able to safely tolerate lying flat then this is an easy method. The patient was placed face down with the dislocated arm over the edge with weights hanging on the wrist. Especially with a busy CCT area this is a good first method as they can relax and you can attend to other patients while they still feel like they are being taken care of. All 3 patients were relocated with this technique and some minimal scapular manipulation.