SAQ 167 – Paediatric Trauma – elbow dislocation and procedural planning

Question 1. elbow dislocation and procedural planning.

a. X-ray abnormalities

• Posterior elbow dislocation.
• Radial head fracture with complete displacement.
• Medial epicondyle fracture.
• Posterior fat pad and soft-tissue swelling.

b. Analgesia approach

• Immobilise in a sling.
• Use distraction such as television or a tablet.
• Nitrous oxide.
• Intranasal fentanyl 1-1.5 micrograms/kg.
• IM ketamine 1-2 mg/kg or titrated IV ketamine.
• IV morphine 0.1 mg/kg followed by small aliquots.

c. Corrective treatment indications

• Neurological compromise.
• Arterial compromise.
• Ongoing severe pain.
• Significant delay to theatre.

d. Managing the situation

• Use verbal de-escalation, apology, and empathy.
• Involve another senior clinician if required.
• Explain the consequences of delayed reduction and the aim of achieving the best outcome for the child.
• Explain that IV access will eventually be required.
• Offer mutually acceptable options, such as IV placement after IM ketamine, nitrous oxide, gaseous induction, or facilitated transfer to theatre.