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Immediate threats and escalation
Time critical risks
Airway compromise from sedation risk
Hemodynamic instability from polytrauma
Limb threat from vascular injury
Open dislocation
Fracture dislocation
Posterior dislocation after seizure or electrocution
Immediate escalation triggers
If absent distal pulses then emergent reduction attempt and vascular surgery
If pulses not restored after reduction then CT angiography upper extremity
If expanding hematoma then direct pressure and operative pathway
If open injury then antibiotics and orthopedics
If gross contamination then add gram negative coverage
If suspected surgical neck fracture then avoid forceful reduction and orthopedics
If neurovascular deficit then emergent ortho
Analgesia and sedation readiness
Dedicated monitoring personnel during PSA ACEP Level C
Capnography adjunct to detect hypoventilation earlier ACEP Level B
Fasting time not a reason to delay ED PSA ACEP Level B
Pre and post reduction safety checks
Neurovascular baseline
Radial pulse quality
Capillary refill
Hand color and temperature
Sensation lateral deltoid axillary nerve
Deltoid activation if tolerated
Median nerve sensation index fingertip
Ulnar nerve sensation small fingertip
Radial nerve wrist and finger extension
Reduction readiness
Pain control plan
Anticipated dislocation direction
High fracture risk features
Age 40 years or older
First episode dislocation
Humeral ecchymosis
Equipment plan
Sling and swathe
Pulse oximetry and capnography if PSA
Suction and airway equipment if PSA
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.