Canyoneering First Aid: Round Two (Dislocated shoulder)

[trackrunner]

For round one: snake bite look here
http://www.bogley.com/forum/viewtopic.php?t=11318

Dislocated shoulder could happen in a canyon. Thinking about what you would do? Would need to reset it or it would get very painful.

Discuss

[rockgremlin]

Prolly just isolate the joint, minimize unnecessary movement, wrap it, sling it, get to hospital ASAP.

If in a deep slot, the person might need to be strapped to a litter and hauled out, especially if there is swimming and/or rigorous downclimbing and/or rappelling involved in order to get out of the canyon. I guess all of this depends on the abilities of the individual. Some people are capable of doing all of those activities with one arm if in a desperate situation (Aron Ralston).

[RedRoxx]

And---no SPOT or GPS to locate you. In some cases a litter is absolutely unable to be brought in. NSS accident reports, experienced cavers usually self rescue, with group support. SAR's are usually for the inexperienced, of course not in all cases. The grotto I belong to here has a few members who also belong to SARA (southern arizona rescue association). Most of us are on a call out list for support for cave rescues.
Had a guy fall in a cave about 50 feet and was unconscious, on a military fort here. Took about 50 hours to get him out, he was also taken by a Blackhawk to nearest hospital where he was released a few days later.
It was sort of a cluster with all the agencies involved, too many people in the cave not knowing what they were doing in that environment. And a lot of vertical in that cave, so a couple of the rescuers became hypothermic from standing around too long on ledges.
I didn't get to go on that one, but been in on a couple of more minor disasters ( sprained ankles, cuts, a broken elbow) and we got those folks out in a timely manner and on their way to medical care.

On a shoulder if you can get to them before it gets really bad just putting them in certain positions and sometimes the weight of the hanging arm or some gentle but consistent traction can cause the joint to "suck" back in. Might have a tendency to slip out again so some stabelization might need to be applied. If it gets back in quickly or with minimal trauma the person can be surprisingly functional quickly.

[ratagonia]

For round one: snake bite look here
http://www.bogley.com/forum/viewtopic.php?t=11318

Dislocated shoulder could happen in a canyon. Thinking about what you would do? Would need to reset it or it would get very painful.

Discuss

It's a little more complex than that, so here's a good (short) article about it ( 1.0 Mb pdf format):

http://www.canyoneeringusa.com/rave

Tom

[old.man.surly]

for a dislocated shoulder, my best advice would probably be to relocate it first... no?

[mmac]

On a shoulder if you can get to them before it gets really bad just putting them in certain positions and sometimes the weight of the hanging arm or some gentle but consistent traction can cause the joint to "suck" back in. Might have a tendency to slip out again so some stabelization might need to be applied. If it gets back in quickly or with minimal trauma the person can be surprisingly functional quickly.

This is spot-on. Depending on the type of dislocation and the amount of trauma will tell you whether you can relocate the joint yourself in the field. There can also be issues with leaving the joint dislocated in some circumstances (pinched nerves, blood vessels, etc...). This particular injury tends to be an especially painful one. Without proper training though it's possible to make choices that can hurt people. Please make sure someone in your party has at least a basic first aid/cpr training (note that this level of responser is not qualified to relocate a shoulder). First responder or wilderness first responder would be preferable for those that don't want to get into more advanced (and expensive) training.

http://www.redcross.org/SERVICES/HSS/courses/
http://www.nols.edu/wmi/courses/wildfirstresponder.shtml

Be safe :mrgreen:

[ratagonia]

for a dislocated shoulder, my best advice would probably be to relocate it first... no?

It's called "reducing".

WFR training says:

1. make sure it is a simple dislocation, without also some breakage around the shoulder joint, either side. Reducing a dislocation with a broken socket = mucho bad juju.

1A. how do you make sure? Mostly by the mechanism. If the injury occured by hitting the shoulder, you must assume it is NOT a simple dislocation. If the injury occured with no contact to the actual shoulder, it is more likely a simple dislocation

2. reduction is not always easy, especially if it is the first time, and if there has been some time delay.

3. the kayaker special is a good choice of method, because it is done by the individual. People who do not know how to reduce a shoulder dislocation and try anyway can cause great harm. There's a bunch of good stuff (arteries, nerves) running through there.

4. Reduced, the game is not over. Must monitor sensation and circulation in the hand, incase the nerve or artery is pinched. The arm goes in a sling and is strapped to the body, until the person can get to medical help. Not an emergency (unless loss of sensation or circulation), but one cannot use the arm until it has been xrayed to make sure everything is in the right place.

Tom

[old.man.surly]

so that misunderstood, relatively comical comment about relocating a dislocated shoulder actually had more to do with something being lost and relocated, than it did with reducing a shoulder...
i do understand that my attempts at comedy usually do fall short, i mean my wife makes me promise not to tell jokes when i stand in front of crowds. but i didnt think this one was too far off... not really understandable? not funny? :ne_nau:

sorry rat...

i do not attempt nor pretend to know more than anyone else about first aid.

[AJ]

We had shoulder dislocations on two of our trips; one in Gravel and one in Five Mile. Both victims...err...patients had a previous history of dislocations (which we found out after the dislocation.) One was able to reduce her shoulder alone using a method very similar to Tom's Kayaker special (lean forward and let arms hang, needs to be relaxed, sit up slowly and still relaxed arms and shoulders. Important to let arms hang loosely, go back down if the first up doesn't work. Although, usually it pops back in before you even start to sit up if relaxed.) Then you can also easily try the grab the knees and use traction like Tom's article points out if the sit up and slouch back down didn't work. The second person needed a little help from behind.

In both cases, the person's arm was then okay (blood and nerves) and slung and needed to be helped through all the remaining obstacles; including being lowered instead of rappeling. Sometimes with someone else on a line nearby to help them. It worked out fine, but was a bit slow. Essentially at least double your exit time estimations... Depending on the canyon you are in, could be worse than that... Obviously, it will be much worse if you can't get it reduced/re-located...



Take care,
A.J.

[Sombeech]

my wife makes me promise not to tell jokes when i stand in front of crowds.

She must be out of town this weekend. :lol8: