Ankle fxs

Getting sedation from the ER is a pain in the ass, sometimes not possible, and not having much luck with pain control with intraartic blocks...nurses filing complaints because of perceived insensitivity.

Make sure you give it a few minutes to setup

A helpful technique is to inject/aspirate several times, this assures good mixing of lidocaine w/ the blood in the joint. 8-12cc of 1% lidocaine usually works pretty well.

try to get sedation but if not move on to a little iv sedation w/ big dose of morphine w/ a little ativan since they stop letting us use phenergan in ER. works surprisingly well

Having had CS with the Milk of Amnesia in the past for a cardioversion, it's pretty humane and my go-to for reductions when feasible; bonus is excellent relaxant. Some of our ER guys use fentanyl/versed which is a cruel waste of time and energy. My backup is 10ccs of 2% lido intra-articular w/ a little morphine +/- valium IV. Depends on the patient. For blown-up stuff, our anesthesia residents are usually willing to chip-in when the ER bags.

We don't have a c-arm in the ER at our university hospital, though, so the real question is: "what do you use if you don't get the reduction on first pull?"

Etomidate + versed. Use the C-arm in the ER and do it once.