
Author: EMKF
Emergency Medicine Kenya Foundation (EMKF) is a not-for-profit (NGO) public benefit organisation registered in Kenya
TMJ Dislocation Reduction Made Easy

Syringe Technique: With the patient in a sitting position, the physician places a 5 or 10 ml syringe between the posterior upper and lower molars or gums on the affected side. The patient is asked to gently bite down and grasp the syringe as the patient is instructed to roll the syringe back and forth, resulting in the reduction of the dislocated TMJ.
How emergency response failed Baby Travis in his hour of need

Unfortunately, these cases were purely about poor responses to medical emergencies. The emergency was not what the child presented with, but the need for initial resuscitation and ensuring the patient is comfortable, meaning they are not in pain, even though the theatre was not available.
CT before LP?
- If you think CT will show a cause for the headache, do a CT
- If a CT is indicated for other reasons (depressed conscious level, focal neurology), do a CT
- If a GCS 15 patient is to undergo LP for suspected (or to rule out) meningitis, and they have a normal neurological exam (including fundi), and are not elderly or immunosuppressed, there is no need to do a CT first.
- If you’re seriously worried about meningitis and are intent on getting a CT prior to LP, don’t let the imaging delay antimicrobial therapy.