dislocations Flashcards
how to relocate a patella
Grasp the patella and push it medially (inwards) while simultaneously straightening the knee
non transport requirement for patella dislocation
The patella has dislocated before, and
The patella relocates, and
There is relief of pain, and
The patient can actively bend their knee.
when dose a patella dislocation require an x ray
if it is the first time the patella has dislocated
criteria for a shoulder relocation to occur
The patient has had a previous dislocation of the same joint,
and
The shoulder is dislocated anteriorly,
and
There is no clear evidence of acromioclavicular joint dislocation,
and
There is no clear evidence of a fracture involving the humerus,
and
The dislocation is a result of mispositioning and/or a relatively minor force.
how many attempts at a sholder relocation can be made
two
if the shoulder relocates:
Place the arm in a sling.
Recommend the patient keeps their arm in a sling, avoids using the arm unnecessarily, and is seen in primary care (which may include a physiotherapist) within 48 hours.
Provide advice on taking analgesia. Regular paracetamol and/or an anti-inflammatory medicine (following advice on the packet instructions) is usually appropriate.
indicators of a shoulder relocation
A palpable or audible clunk, and
Relief of pain, and
Return of a normal shoulder shape, and
Return of normal (or near normal) motion of the shoulder joint.
what shape will the shoulder be if there is an anterior dislocation
square
Acromioclavicular joint dislocation would look like….
the collar bone is popping up at the delt
outline some possible complications of sholder relocation
displacing a fracture sustained at the time of injury or causing a fracture during relocation. This is the reason for only attempting relocation if the patient has an anterior dislocation of the shoulder in the setting of previous dislocation.
outline The modified Kocher’s technique for shoulder relocation
Position the patient supine or sitting, with the arm by their side.
Bend the elbow to 90°.
Apply traction to the humerus and slowly externally rotate the arm until resistance is felt (usually approximately 45°).
Slowly abduct the arm, as if to scratch the back of the head with the patient’s hand.
Massage the head of the humerus if the shoulder does not relocate.
outline the Stimson technique for shoulder relocation
Place the patient prone on the stretcher with their affected arm hanging down, ensuring the stretcher height is such that their arm does not touch the ground.
Apply continuous downward traction on the hand or wrist for several minutes.
Maintain traction and gently rotate (supinate) the hand and wrist outwards if the shoulder does not relocate after several minutes. Maintain this position for several minutes.
Apply scapular rotation if the shoulder does not relocate after several minutes. Push the lower pole of the scapula (shoulder blade) towards the spine, whilst maintaining downward traction on the arm.
fent, midaz or methoxy can be administered and non transport the patient as long as….
Has a GCS of 15, and
Is in the care of a competent adult, and
Is instructed not to drive a vehicle or operate machinery for at least 24 hours.
analgesia for digit dislocation
administer a ring block as first point of call
when should An attempt to relocate/realign a dislocated or severely deformed wrist, knee or ankle joint occur
usually occur, particularly when there is impaired sensation or perfusion distal to the injury, unless time to hospital is less than 15 minutes.
what is the primary form of analgesia for wrists/knee or ankle (or other misc) prior to relocating
ketamine for dissociation
(0.5mg/1mg per kg up to 100 mg, use disassociation checklist)
how to relocation dislocations without a specific guideline
Provide sustained longitudinal traction of the limb with an assistant providing counter-traction above the injury site.
when is time critical relocation important
If there is compromised sensation or perfusion distal to a dislocated/severely deformed joint (including compromised perfusion of skin overlying the dislocation)
management of a dislocation if it is believed to be complicated by fracture
- if associated with force there is a high chance the dislocation will be associated with fracture
-the presence of associated fractures (including compound fractures) does not change the need to relocate/realign the joint if this is clinically indicated.
management of:, a dislocation or severe deformity of the wrist, ankle or knee ,in the absence of compromised perfusion or sensation
should be relocated/realigned as soon as possible because of the high risk of damage to nerves and blood vessels. This should usually occur out-of-hospital unless time to hospital is less than 15 minutes.
If relocation is indicated because of distal ischaemia but is not achieved,
applying longitudinal traction is the best method for restoring circulation, if this is feasible.
The affected limb must always be assessed for
perfusion, sensation, and movement distal to the injury. This assessment must be repeated after any attempt to relocate the joint.
relocation of an elbow is indicated if
there is a prolonged transport time or there is impaired sensation or perfusion distal to the injury.
sounds to expect when relocating an ankle
Relocation will often correct with a ‘clunk’. Dislocations with fractures may produce a grating sensation with no clear end point. If this occurs continue applying traction until normal alignment is achieved.
a dislocated hip most often occurs…
with a prosthetic hip, seek clinical advise for hips
