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Our hospital's pediatric emergency department sees about 75,000 children
annually.

the department  has amongst it's senior staff 4 pediatric medicine trained
specialists and 1 general emergency medicine trained specialist.  We ,
together with our medical officers ( residents) have been doing upper limb
fracture reductions under conscious sedation (mainly using IM or IV
ketamine) or Bier's block. We have also a set of departmental guidelines
regarding what fractures can be treated in the ED and what fractures
require admission.

We have enjoyed doing these fracture reductions and it also adds to our
work satisfaction to be able to reduce unnecessary orthopedic admissions.
The nurses are competent in assisting us in this.  Upon discharge, the
patients are given a set of plaster cast  care advice.

If the position of the fracture fragments is not acceptable after attempts
at reduction, we are free to admit the patient.

The pediatric orthopedics department has been supportive of our services in
the following ways:

1) Provision of specialist outpatient clinic appointments for early review
the next working day - this helps to pick up any missed fractures,
re-displaced / malpositioned fractures early for definitive intervention.
This early review system gives us the assurance that morbidity will be
minimised even if the reduction in the ED is unsuccessful.

2)Pediatric Orthopedic Registrar ( fellow)/ consultant ( staff)  on call is
available for consultation anytime.

There has been negligible morbidity so far as a result of Pediatric ED
doctors doing fracture reductions because of this strong support from the
Orthopedics Dept.

Dr Angelina Ang
MBBS (Singapore), MRCP (UK) Pediatrics
Associate Consultant
Children's Emergency
KK Women's and Children's Hospital
Singapore

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html