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To establish current UK practice for the management of the acute traumatic shoulder dislocation with respect to analgesia and reduction manoeuvres. To compare the transit times of patients through an emergency department (ED) after the use of intravenous analgesia and/ or sedation compared to entonox +/- simple oral analgesia.A postal questionnaire was sent to 100 UK ED consultants to establish current practice. The treating clinicians were allowed to choose the method of analgesia provided to reduce the patient's dislocated shoulder, provided the patient was happy with it. They administered either (1) traditional intravenous morphine and/or midazolam or (2) entonox +/- simple oral analgesia to facilitate reduction. A prospective audit was conducted to compare the transit times of the two groups of patients.The postal questionnaire revealed that intravenous morphine and midazolam are widely used during reduction of the acute shoulder dislocation in the UK. The audit showed that this was associated with a significantly prolonged transit time through the ED, compared to entonox alone, (mean 77 min versus 177 min, respectively, p<0.001) without compromise in reduction success.Entonox +/- simple oral analgesia significantly decreases ED transit times as compared to IV morphine and/or midazolam for the reduction of the acute traumatic dislocated shoulder. Further studies should be done into patient pain scores and into the best combination of oral analgesia and entonox.

Original publication




Journal article


Accident and emergency nursing

Publication Date





223 - 227


Emergency Department, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK.


Humans, Shoulder Dislocation, Acute Disease, Oxygen, Nitrous Oxide, Morphine, Midazolam, Analgesics, Anesthetics, Combined, Hypnotics and Sedatives, Treatment Outcome, Emergency Treatment, Manipulation, Orthopedic, Length of Stay, Analgesia, Conscious Sedation, Infusions, Intravenous, Prospective Studies, Emergency Service, Hospital, Drug Utilization, Medical Audit, Surveys and Questionnaires, Practice Patterns, Physicians', United Kingdom