A shoulder dislocation is a common ailment in the ER. Once you have reduced thirty or forty of them you can get a knack for doing it and, as is supported in the literature, getting the dislocated joint back in place as soon as possible is best for the patient in terms of recovery AND in terms of immediate pain relief.
If I can lock eyes with the patient and get them to trust me, especially in a young patient, I can often get the joint relocated without conscious sedation or pain medicine.
During the relocation of the joint I really do use the force... the power of suggestion, to help the patient allow me to move their arm around. In fact, it is a rare event now that someone with a shoulder dislocation gets an Xray before I relocate the joint.
There are physical findings and history that point to shoulder dislocation and the above XRay is the first one I've taken, after relocating a joint, where I also found a fracture.
This particular patient was very susceptible to the power of suggestion because they let me crank on their broken arm and dislocated shoulder until it was back in place and then they went promptly to sleep. A real trooper. Didn't even ask for pain medicines to go home. No, they were not drunk or high. Cowboys are tough, "Just do it doc."
I look forward everyday to all of the post from the group. Not seeing alot lately. I am missing you guys.
ReplyDeleteAs for the shoulder of the cowboy, glad it wasn't me.
911 is an idiot! His first clue should have been "cowboy"
ReplyDeleteA real Cowboy, unlike a "hockey player" is a real man. Had a kid come into Helana,MT one time with a broken femur off a bull ride..Drove home 400 miles to Calgary in the back of a pickup truck to avoid paying $, just getting back to "free health" care..No telling how long it took to put a rod in his femur once he got there tho..
Otherwise old ladies are the other group to avoid manipulation before xray..
In general, U only need 1 xray. Either before or after the reduction. But getting it back in is the best medicine and pain relief..OF
Cowboys have nothing on hockey players. I can handle anything but my ex wife for 8 seconds.
ReplyDeleteOuch!
ReplyDeleteWatch out Dodge City's Malpractice Attorney, Bartavius P. Fink, who'll haul you before the Territorial Court for Assault and Battery for breakin the poor Cowpokes Arm when he didn't pay off an old Poker Debt. And the Judge in the towns got bloodstains on his hands...
ReplyDeleteAnd those cowboys start young. My 9yo nephew walked 200 yards to the house, and had gotten an ice pack, some tylenol, and was lying on the sofa with his leg up watching TV when my BIL found him. "Kicked by a cow" was the explanation. broken Tibia was the diagnosis..
ReplyDeleteWe have recently been the host to the National High School Rodeos. I found it quite different than our usual clientele to have these young gentlemen and ladies come into the ED. They were quite respectful, and
ReplyDeletecourteous. As you also noted,they were able to tolerate a lot before they asked for something for pain.
tough people are a dying breed,,,fibro rules!!!!!!
ReplyDeleteBest damn rodeo there is? The prison rodeo in Huntsville, Texas.
ReplyDeleteA REAL cowboy would have popped his own shoulder back in place.... just like what Chuck Norris would have done!
ReplyDeleteI insist on 2 x-rays: one prior to reduction to document that the joint was actually dislocated and not broken prior to my procedure (and to justify the bill for the procedure) and one afterwards to document successful reduction and that I didn't cause an injury during reduction.
ReplyDeleteI've done a few shoulders without sedation by getting an assistant to apply traction inferiorly while I rotate the scapula clockwise, but some patients won't tolerate that method.
You want to see a tough breed, try writers. How many times do we stick our quills in our eyeballs in order to avoid a bad day of writing. Do we seek help? Hell no. We screech like a banshee and rewrite the scene.
ReplyDeletemmmm...cowboys.
ReplyDeleteMy Heroes have aways been Cowboys....
ReplyDeleteMy Dad broke both legs when he was 13 while riding horses: One under each leg standing up. Yeah, those are my genes...explains a lot re: my kids!
ReplyDeleteI love the farmers and Mennonites too. They are so no-bullshit. If they are actually in the ED, IMHO they should always get triage priority 1 because you KNOW something is really up.
ReplyDeleteWord verification: rusisses
(are you sissies?)
A friend of mine used to dislocate his shoulder all the time (eight or ten times before he had it cut on). By the sixth or seventh time, he was popping them back in himself. Can't say he wasn't drunk, though...
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