It’s a Saturday Night and you have won the rota lottery and are on the backshift. It is busy, as always. Ten patients in you pick up the 68-year-old Jock MacDonald, who is on holiday from the Western Isles.

He was walking around the city center after a few too many Hogmanay bevvies at Hootananny, tripped over the pavement and fell on his outstretched right arm.

He complains of a reduced range of movement and thinks his shoulder “looks awfy funny”. His AP radiograph is shown below.

Case courtesy of Dr Jeremy Jones,, rID: 7132

Great, you have an opportunity to practice your Cocker’s technique! But first, you wonder about how you are going to sedate him.

The wait to be seen by a clinician has given Jock time to sober up. On further questioning Ronald admits to having a few drinks when he was on the mainland. He works a croft and describes himself as “thrawn”*, is on no regular meds and keeps fit and well. He does, however, have a rough beard and a very short neck!

You are going to have to put some serious thought into this sedation. You would usually use a propofol bolus, but with his beard and short neck you want to get the sedation just perfect! You recall reading a recent paper about target controlled propofol infusions in the emergency department and decide to explore this further.

*Editor’s note: I do not know what this means.

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