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Matthew99

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

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I splinted my first dislocated shoulder I think, just because I thought I was supposed to. Since then I've always allowed them to self splint, which seems to make them happiest. They'll move it to a place where it's most comfortable, then you can help support it with pillows if necessary, but usually that's all that's necessary....

The exception being if I need to snow them for pain, and I can't trust them to hold it a place where it won't be compromised in some way, but having to knock them down that far has been rare in my limited experience..

Of course I mean 'usually' in it's truest sense..nothing is for sure each time...

Dwayne

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Not usually in urban/suburban settings and only in certain circumstances in the wilderness if you have the qualifications. Not something you should ever be trying though if you can get to a hospital or a place with higher level of medical care.

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Are paramedics allowed to pop back shoulders into place?

In New York State, emphatically NO.

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When I worked in NC, we were allowed to attempt one (1) realignment. I never did though and to be honest, I really didn't see that many dislocations. Many fx's however.

As far as splinting, I would usually allow the pt. to self splint. Then place a triangle bandage (just unrolled, not unfolded) around the wrist and tie it behind the neck. A roll of kerlex just so the knot wasn't resting on the pt.'s neck. This would allow for some support in the event the pt. lost his grip due to a bump in the road or whatever. Pain mgmt sometimes (ok, most times) would cause the pt. to drop his hand or loosen his grip. Adapt, improvise and overcome.

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The reason in my mind for not reducing a dislocation is the possibility of fracture. Even ER docs don't reduce shoulder fractures without x-rays and we shouldn't be doing that either.

What happens if it's not a dislocation but a humeral head neck fracture with that presentation? Try to put that one back in place and you are not going to be successful and more than likely sued big time.

I've never seen a doctor reduce a shoulder dislocation without an x-ray first. Never. But I'm sure others have.

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A knee dislocation on a trail rescue was the only time I've ever used the PO medications from the AW-EMT kit. However, it wouldn't be a possibility to treat or reduce again, b/c all of our certifications expired on 1-1-11. I used the cert maybe twice, so I'm not going to re-certify. The patient didn't require it, good SMC. However, in placing the patient on a board (b/c even chest pain patients get immobilized), the knee slid back into place, and then... He was in worse pain than before. >2HR Hike, WEMSI Protocol goes into effect.

I should add.. The plan was to immobilize in place. It didn't work out, leg was flat, and it sort of pulled back into place. That is a knee weakening sight! confused.gif

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Agreed with Ruff. I've never reduced a shoulder without an xray. Shoulder dislocations are pretty obvious but an additional fracture may not be so obvious. I beleive NYS allowed us to reduce a dislocation in the field if there was vascular compromise (this was back in the 90s).

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