Tricks of the Trade: three procedural tips for the ED
Three techniques that have helped in the emergency department: one for shoulder dislocations, one for ear foreign bodies, and one for mandible dislocations.
1. The "Park-It" technique for shoulder reduction
In my experience, this technique feels the most natural, causes the least pain, and succeeds most often.
How it works
The provider places a fist in the patient's axilla as a fulcrum. The patient's elbow is then adducted and axially distracted against it, which slides the humeral head back over the anteroinferior lip of the glenoid rim.
If you do one thing, watch the video: Park-It shoulder reduction (YouTube)
Originally described by ALiEM: Trick of the trade: Got a shoulder dislocation? Park it!
2. Ear foreign body removal: the suction technique
Ear foreign bodies can be frustrating. One useful technique uses the largest tracheal suction catheter that fits in the ear canal, with water added if needed. It works well for small objects, such as pieces of a hearing aid, and other foreign bodies.
3. Extra-oral reduction of anterior mandible dislocation
Worth practicing:
It can avoid procedural sedation.
Your thumbs stay out of harm's way.
It can be very fast.
Clinical pearls
Have more than one reduction technique ready. When the first fails, a different mechanism often succeeds.
Ear foreign bodies: suction is gentle and often faster than forceps for small, smooth objects.
Extra-oral mandible reduction keeps your fingers safe and often needs no sedation.
Have a trick of your own? Send it in to be considered for a future Tricks of the Trade installment.
