title: Prospective audit of emergency department transit times associated with entonox analgesia for reduction of the acute, traumatic dislocated shoulder.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emergency Department, Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK. mjdescamp@yahoo.co.uk
authors.forename: M J L
authors.initials: MJ
authors.lastname: Descamps
authors.forename: S
authors.initials: S
authors.lastname: Gwilym
authors.forename: D
authors.initials: D
authors.lastname: Weldon
authors.forename: V
authors.initials: V
authors.lastname: Holloway
mesh_terms: D000208:Acute Disease; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data; D000700:Analgesics / Q000627:therapeutic use; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D016292:Procedural Sedation / Q000379:methods / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data*; D008349:Manipulation, Orthopedic / Q000009:adverse effects; D008485:Medical Audit; D008874:Midazolam / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D009609:Nitrous Oxide / Q000627:therapeutic use*; D010100:Oxygen / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D012783:Shoulder Dislocation / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000700:Analgesics; D019162:Anesthetics, Combined; D006993:Hypnotics and Sedatives; C001147:Entonox; D009020:Morphine; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen