Thursday 18 October 2007

Pulled elbow

A 2 year old girl came in at about 9pm at night while I was trying to reduce another child's forearm fracture. Her mother said she has not been using her left arm. Her left arm was just hanging there-motionless. She was pushed over by an older child and landed on her left side. Even though history does not suggest a pulled elbow it was the way it looked and on palpation of her whole arm, she was not in pain at all. I hadn’t done Emergency as part of my rotation and I have no idea how to fix it. So I had to go to the books. Since it was 9pm that night and I don't know how to fix it, I sent them home and told them to return in the morning. There’s a really good surgical book that a friend had recommended to bring ‘Primary Surgery’ and sure enough, it had great instructions and pictures. That's what I do a lot of the time. I read during my free time, not leisurely books but medical books. I read up on how to reduce fractures, what to do in obstetrics emergencies, and I do that all before bedtime as that is the only time I have. The power goes off around 10pm so after a shower, I wear my headtorch and get to reading. The next morning, mom and child turned up. I practiced first on one of the nurses and then I attempted on the child to put that elbow back. I had to try twice because I wasn’t sure if it worked the first time. There was no click and I didn't feel anything. The child didn’t cry at all. The next minute she gave me this huge smile and started moving her arm. It was the most beautiful smile and she made my day!

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