Month: June 2015

Neil Cunningham’s shoulder reduction video gallery

Shoulderdislocation.net is no more, but thankfully Neil Cunningham has left his video collection on Youtube. This is the ultimate collection of shoulder reduction videos. Techniques you can learn here include:

The (drug-free) Cunningham method
Kochers method
Scapular Manipulation
Modified Milch
Zero Position

As well as some tips on troubleshooting tricky shoulder dislocations.

We’ve already posted the first video, and we recommend you start with this (Neil’s excellent talk on all things shoulder dislocation) and will re-post the Cunningham Method video with some tips soon as well.

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Shoulder reduction: Cunningham Method 1

This is a great, drug free way to reduce a shoulder, invented by Neil Cunningham. As Neil mentions in his definitive talk about shoulder dislocation and reduction, there may be times when you elect not to use this technique, but in patients with minimal pain/spasm, who can get their arm into the adducted position, it’s worth a shot if it avoids a potentially unnecessary procedural sedation.

Key points:

Have the patient sitting as upright as possible
Get the arm as adducted as possible – patient’s elbow as close to their side as they can
Continually remind the patient to sit up straight, take slow deep breaths and relax their shoulders
Shorten the biceps by flexing the patient’s elbow and rest their hand on your forearm/shoulder – this will prevent it pulling the humeral head medially
Massage the trapezius, deltoid and biceps
You won’t feel the classic “clunk” you get with traction techniques – but you will see the “step” disappear.

Reference:

A new drug free technique for reducing anterior shoulder dislocations. Cunningham, N. Emerg Med (Fremantle). 2003 Oct-Dec;15(5-6):521-4

Posted in Joint reductionTagged shoulder, shoulder reduction

Shoulder reduction – The definitive talk by Neil Cunningham

Neil Cunningham who ran (the now defunct) shoulderdislocation.net site gives an amazing overview of shoulder dislocation and reduction. This is the definitive presentation on shoulder reduction, outlining the biomechanics of dislocation/reduction, patient factors that may make one technique more useful than another, risks and complications of various techniques, and some awesome pearls and demonstrations, including many tips on drug-free shoulder reduction.

We’ll post more of Neil’s videos soon.

Posted in Joint reductionTagged shoulder, shoulder reduction

Elbow reduction: interlocking hands technique

This is a simple technique for reducing dislocated elbow joints. May take a bit of strength, but the physics make sense!

Posted in Joint reductionTagged elbow, elbow reduction

Hip reduction: Whistler technique

This is a straightforward technique for reducing posterior hip dislocations.

Key elements of the technique are:

Flex the patient’s unaffected leg at the knee
Flex the knee on the affected side, slide your arm underneath placing your hand on the knee on the unaffected side, and use this as the fulcrum
Lift with your legs (avoid lifting with your back!)
Gently internally/externally rotate the affected hip whilst lifting
Ensure you have an assistant placing downward pressure on the pelvis/ASIS

Posted in Joint reductionTagged hip, hip reduction

Procedural Competency: learning and keeping new skills

This is a great podcast from Todd Fraser at Essential Critical Care (and Osler Technology fame). Todd interviews Associate Professor Marcus Watson who is the executive director of the Clinical Skills Development Centre in Brisbane about procedural competency.

Listen to the podcast here

Marcus describes how in healthcare we’re still pushing the boundaries of what we can treat, and what new treatments are going to be in 5-10 years, and very little of our attention goes towards how well we perform various tasks.

He also discusses comparisons with other industries such as aviation, where there are vested interests that place a much higher priority on analysis and measurement of competency, and the reasons behind this. An important issue in healthcare is the diverse range of skills, systems and organisations we operate in, so trying to define all competencies (for example from a legislative viewpoint) is very difficult, and there is also no single regulatory authority in healthcare (as compared to aviation). But over-regulation also has drawbacks and limits.

The definitions of competency, proficiency and mastery, and how we measure and judge these are covered, as are the various factors that affect our learning of new procedures.

This is a fascinating interview for anyone interested in procedural skill learning and competency in healthcare, and is highly recommended listening.

Posted in Procedure TrainingTagged Procedural Competency

CT-6 Femoral Traction Device 1

This is a video made by Queensland Ambulance Service on how to apply the CT-6 Femoral Traction Device. The CT-6 by Fare-Tec is becoming more widespread for pre-hospital use in Australia as it’s much more compact and lightweight than the old Donway splints, so you may see one popping up in your ED soon.

Posted in Plastering & SplintingTagged splints, traction

CT-6 Femoral Traction Device 2

The CT-6 by Fare-Tec is becoming more widespread for pre-hospital use in Australia as it’s much more compact and lightweight than the old Donway splints. This video demonstrates how to apply the CT-6.

Posted in Plastering & SplintingTagged splints, traction

Upper Limb Plaster Splint Templates

Thanks to George Douros for allowing us to use his excellent plaster slab guides and templates for forearm injuries. These are designed to be used on the floor in ED, so feel free to print them out and try them today!

(Tip: To print the templates, click on the “Download” link below each document, then print)

1) Charnley Slab (Colle’s Fracture)

2) Thumb Spica (Scaphoid or suspected scaphoid fracture)

3) Volar Slab (Carpal, metacarpal and finger injuries)

Posted in Plastering & SplintingTagged plaster, POP slabs, splints

Rapid Infuser Catheter – How to save a life with a 20 Gauge IV

This is a quick video I did over at the ETM Course blog. If you don’t now about RIC lines (rapid infuser catheters), watch this video, and read my other post about large bore vascular access devices!

Posted in Vascular AccessTagged Rapid Infuser Catheter

Ultrasound guided radial artery line Insertion

This is a great video demonstrating ultrasound guided radial artery line insertion. I’d recommend watching until the end for the troubleshooting tips and tricks. I’ve been doing radial artery lines for over a decade and didn’t know some of these simple tricks for what to do when you’ve hit the artery but the cannula won’t feed, this will surely save you and your patients much frustration in the future!

Posted in Vascular AccessTagged Arterial line, Ultrasound

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