I’ve been doing a locum the last few days and have had a large number of patients with shoulder dislocations. Without the staffing facilities to reduce with full sedation, I went back to nitrous and in some cases to reducing whilst calming the patient down, with no sedation. I was surprised at how well they worked and how quickly the patients were able to leave the ED. Maybe it was the picture I painted of a beach in the Bahamas.
When finishing up, I looked up the literature and found a great video and then looked at the literature.
Here is a great new method called the FARES Method for reducing shoulders. These are the sort of reductions you don’t want to sedate for. FARES stands for Fast , Reliable and Safe.
More and more I find I’m doing shoulder reductions with nitrous, but every now and then do them with no sedation. Now you may not be able to use this on all patients, as some are just in so much spasm and pain, that they won’t allow you to lie flat. Others, however, may be easier. It’s this patient group that you can reduce the shoulder on without sedation.
This new technique, when compared to the Hippocratic and Kocher techniques, was found to be more effective, faster and less painful. JBone Joint Surg Am 2009 Dec;91(12):2775-82.
Here is a great video from Vanderbilt Emergency Medicine, that demonstrates the techniques.