shelbyjohnson wrote:
Squeamish skip next paragraph.
Another episode of traction was attempted that caused severe pain and Nick turned very pale. Shortly afterwards he was ready to try again. We talked through another strategy that Bob offered having seen done once before. Kyle and Chris sat down on Nick’s right to brace him pulling his torso in their direction. Bob sat down opposite on Nick’s left and put his foot underneath to crook of his armpit and held his left hand as if in a rowing machine position. Chitwood braced from the rear of the left shoulder and I had the bicep pulling in the same direction as Bob. Altogether we all applied slow steady pressure straight out. I would guess we were applying well upwards of 50 pounds of force probably more. The traction worked to ease the pain but it would not relocate even after attempts at rotation while in as much traction as we could muster.
As a Wilderness Medical educator, I would like to make some comments on this. First and foremost though, I would like to say that it is clear everyone in this situation acted with intelligence and commitment to the care and safety of Nick and the rest of the party. That is always the most important responsibility of any rescuer. Great work!
I would recommend to everyone that they consider a wilderness first aid class of some sort. When we teach the reduction of shoulder dislocations, we cover several points that might have helped everyone in this situation. The only recommended procedure according to Wilderness Medical Society protocols is to have the patient lay face down on a flat surface with their injured arm hanging down. A weight is then affixed to the injured arm, and then you have to give the injury TIME! It can take as long as half an hour for the very strong muscles in the area to relax. <liability reduction>
This procedure is very specific, and this description is not training to do the procedure </liability reduction>
The other thing we would say in a class is that this shoulder MUST be protected for a good while. No one knows what decision might have been made if Nick's shoulder dislocation had been reduced in the field, but hiking out would have been much safer for the injury than paddling down stream.
Finally, I want to address the comment that the injury "wasn't life threatening". It certainly sounds like this is an accurate statement for this situation, but everyone should know that
in general, dislocations can lead to loss of a limb or loss of life! Dislocations are pretty traumatic, and can destroy nerve tissue and veins/ arteries, causing loss of function or severe internal bleeding. As a general rule, most dislocations, even ones that can be reduced in the field, should be treated as emergencies which require immediate evacuation by the most efficient and safe method.
</soapbox>
Again, very glad everyone is okay. Good work, one and all! and I hope everyone will consider some further training on wilderness first aid.
Thanks,
Paul
