Improving Throughput, Mythbusting

Less paperwork, equal efficacy with shoulder blocks.

Raise your hand if setting up conscious sedation is a small act of God in your ED.

Glad to see you’re all still here. Now, lets talk about how we can reduce that paperwork, and make the best use of nursing & clinician time in a busy ED.

The June AJEM issue compares suprascapular blocks (21 patients) to Ketamine procedural sedation (20 patients) for shoulder dislocations. There was no difference in success or patient/physician satisfaction. Time spent in the ED was significantly longer in the sedation group, and side effects were not observed in either group.

Previous studies looking at intra-articular lidocaine vs conscious sedation (here, hereand here)  also showed a decreased LOS without a difference in satisfaction, pain control, or efficacy.  Shoulder blocks and intra-articular have great efficacy in all the studies I was able to find, all showing excellent pain control and improved LOS. The caveat is this study  which shows that if a patient has had conscious sedation for a shoulder reduction in the past, they would prefer conscious sedation over a block.

You can review how to do an intra-articular block on YouTube  thanks to Mike Stone and Academic Life in EM.

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