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A normal story, with no 'sex'

Posted

Ok, so let me set the scene and see what you think.

10yrs ago myself and 2 american nurses start at the same time at the same boarding school, with no school experience, just ED. We had no one to show us the ropes, and the headmaster told us we had free reign to do what we see fit.

Anyway, the setting: Ambulance is 30mins away, and the village doctor is away for night, on a rare night off, and so the closest emergency GP was 30 minutes away, which is the same distance as the hospital.

Anyway, we get a call to the gym as a kid is screaming. I get there, and he's landed on his left shoulder, and it is obviously dislocated. We get him on a table, lying face down, and the affected arm hanging off it as it's the most comfortable.

Now, you suddenly realise how alone you are - no x-ray, no doctor nearby, no nothing, except a first aid bag. I call my colleagues and they dash over to lend a hand.

The problem seems like a simple dislocation, and it's easy to see as the kid is tall and skinny, and his collar bone looks ok, but he is screaming the place down. We are about to call the ambulance, when one of my colleagues tells me she has helped put dozens of shoulders back in, and she wants to do it.

I don't know what to say, as it's out of my scope of practice, but the ambulance is 30 minutes away, and by the time the kid get to hospital, that's an hour away, plus I don't relish the idea of driving him screaming in a car down a windy, wet road at night with him like this. I don't know what to do, the kid is screaming bad. So I stand back and watch.

My friend rolls up a sheet, wraps it around his shoulder, and around her waist, and slowly, every so gently pulls, and - pop - the relief is instant. The kid is so relieved.

After assessing the arm/shoulder, we can't see any sign of a break, and he's got a strong radial pulse, and his arm is nice and warm, and he's profusely happy for what my colleague done.

We give him some ibuprofen, a sling, and send him to the doctor in the morning, who congratulates us on a job well done, although does of course do any x-ray to make sure there is nothing broken in there.

To this day, I don't know if we did good or bad. I've discussed it with colleagues and have had people say we did good, and others say we over stepped our bounds.

Your thoughts.... and I hope I've given enough info this time.

Edited by nursingaround1

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

I do not think anyone should attempt it if they had just heard or read about how to do it. But if she's done it several times before successfully, then I think she did the right thing.

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency. Has 21 years experience.

Your friend (with or without training) field reduced a shoulder dislo. You were a short 30 minutes from help. You answer the question.

Your friend (with or without training) field reduced a shoulder dislo. You were a short 30 minutes from help. You answer the question.

Driving not an option due to conditions road/weather/nightime- ambulance to and back from hospital total time 1hr. Risk of circulatory/nerve damage - no idea.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Glad it has a good outcome. Probably not a risk I would have taken if he had good pulses and such with the dislocation.

I had a similar situation as a camp nurse. Staff member with no previous sting allergy documented, now with about a dozen wasp stings and hiving up, telling me her throat felt scratchy, swollen eyes. A solid 15 minutes to wait for an ambulance and 45 minutes to get to a hospital. I had other camper's and staff's epipens I could have used. I ended up giving her 50mg of Benadryl chased with a huge glass of warm water while we waited for the ambulance, had her lay down, and sent her on her merry way. She ended up fine by the time she got to the hospital. They gave her a medrol dose pack and an epipen script just in case and she was back with us by dinner.

This story dates from 10 years ago....are you still employed by this facility?

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

That would be out of my scope as a school nurse.

That would be out of my scope as a school nurse.

I would never do it either, but I did stand back and let my colleague. She was really calm and confident - not that this means anything. But it one of my first emergencies outside of a nice controlled ED, and it made me realise how vulnerable we were.

Farawyn

Has 25 years experience.

I would have called an ambulance. His ABC's weren't compromised. I have seen kids dislocate in sports, yes, the pain is bad, but not life changing.

This is why I tool a wilderness first aid course, so I would know how to do this sort of thing prn. Shoulder dislocations aren't uncommon, but the longer you leave them, the harder they are to put back. Somebody who's had multiple ones, and this isn't uncommon either, will ask you to help put it back right away, and he usually knows how.

Farawyn

Has 25 years experience.

This is why I tool a wilderness first aid course, so I would know how to do this sort of thing prn. Shoulder dislocations aren't uncommon, but the longer you leave them, the harder they are to put back. Somebody who's had multiple ones, and this isn't uncommon either, will ask you to help put it back right away, and he usually knows how.

My mom, who is a retired nurse, could do it, and has. I never have.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

I don't know about your country but in the US the nurse acted outside her scope of practice and can be sued and have her license suspended, revoked, or restricted.

It was inappropriate for this nurse to take that action when EMS was a "reasonable" amount of time in responding and the patient was niot showing any CNS ABC/circulatory compromise.

In your country it may be different but in the US this was inappropriate.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

I would never do it either, but I did stand back and let my colleague. She was really calm and confident - not that this means anything. But it one of my first emergencies outside of a nice controlled ED, and it made me realise how vulnerable we were.

In some states in the US standing by nad doing nothing makes you just as responsible.

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

Aaannnnd Esme's back in action! Go Esme:yes::yes:

I know parents (laypeople) who after being taught by an ED doctor, were able to successfully relocate their son's shoulder on multiple occasions, so I would be open to a nurse who had the knowledge skills and ability to relocate a shoulder, doing so.

In some states in the US standing by nad doing nothing makes you just as responsible.

Yes, you are right, but what can you do to stop her? Also, I would like some thoughts on the increasing risk to circulation/nerves, if left like that for an hour, because, in all practicality, that is how long it would have been before he was treated, at the earliest.

Yes, you are right, but what can you do to stop her? Also, I would like some thoughts on the increasing risk to circulation/nerves, if left like that for an hour, because, in all practicality, that is how long it would have been before he was treated, at the earliest.

If left for awhile like that, the muscles tighten to the point where increased force requiring anesthesia will be necessary to replace it. Increased risk related to the force and the anesthesia, avoidable, particularly unnecessary for a repeater but not insignificant for anyone.