Dislocated shoulder: what to do when the usual position hurts?

#31 Richard B the EMT

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Posted 15 April 2012 - 03:58 AM

The pillow/double swath method is actually quite well known for elbow involved splinting, at least around NYC

#32 DwayneEMTP

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Posted 15 April 2012 - 05:33 PM

I think that self splinting here is perfectly acceptable. Just let them hold it where it feels best and adjust when necessary giving them a pillow for support if needed, which it probably will be.

This is maybe not the best option for all, as many will feel uncared for if you explain for them to hold it where it feels best, but when I was greener I had a couple of people ask me if they 'could just hold it' while I was trying to do all of the things I'd been taught in school and I thought, "Hmmm...why isn't that just as good, or maybe better?"

#33 Lone Star

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Posted 16 April 2012 - 04:13 PM

Either a pillow between the arm and the body, or a nicely folded blanket or two. This helps keep the extremity in a 'position of function' as well as cushion it from bumps and jars incurred during transport.

Another consideration would be that we shouldn't be 'stingy' with pain management techniques, as letting our patient suffer simply because we don't agree that their 'owie' hurts as much as they say it does; is abusive and inexcusable...

#34 ERDoc

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Posted 16 April 2012 - 06:25 PM

In any fx/dislocation, I'd say let the pt put it in the position of most comfort as long as it doesn't compromise blood flow. Lot's of pain medicine.

#35 Kiwiology

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Posted 16 April 2012 - 07:14 PM

In any fx/dislocation, I'd say let the pt put it in the position of most comfort as long as it doesn't compromise blood flow. Lot's of pain medicine.

*Kiwi rummages around in the hip pouch

40mg of morphine
200mcg of fentanyl
400mg of ketamine

Could any of those be helpful at all? I dno I was never very good at this medical stuff ....

Edited by Kiwiology, 16 April 2012 - 07:17 PM.

#36 croaker260

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Posted 16 April 2012 - 08:13 PM

Always position of comfort for a dislocation, which means most ready-made splints probably won't work. It sometimes calls for creative splinting and the filling of voids, but pain management is key since we do not reduce in the field unless there is vascular compromise (never seen that happen with a dislocation). I've accidentally reduced a dislocated knee once. Attempting to make the patient comfortable and applying a splint, I think the patient had a muscle spasm and suddenly went from agony to screaming OH MY GOD, and let out a huge sigh- he was damn near orgasmic. LOL Scared the crap out of me. After undoing all my splinting handiwork, I saw the patella had indeed returned to it's normal position.

Please see the related topic on dislocated patella .