Nerve blocks in the ED.
Which of the following is TRUE about digital nerve blocks.
After giving myself one I can say with certainty they are not painless. You can use the traditional 2 injection technique on the dorsum of the hand or the single needle technique on the palmar side.
A 28yr old man stepped on a sea urchin. What nerve would you block to numb the plantar aspect of his foot?
If you block it at the upper level of the medial malleolus or higher you will get it before it gives of it's terminal branches---the medial plantar, lateral plantar and medial calcaneal. Below is a video link showing the posterior tibial nerve on ultrasound.
Which nerve provides the sensation shown as purple in the diagram and can be blocked in the forearm?
A great block to be comfortable performing in ED. Below is a link to a video of Dr Jacob Avila having it performed on himself by a colleague.
Unwisely you perform a femoral nerve block, serratus anterior block and a brachial plexus block on a 60kg man. He deveolps peri oral tingling, tinnitus, agitation and then has a seizure. What is the most likely diagnosis?
You have exceeded the safe local anaesthetic dose and caused toxicity---not good. Along with "normal" resuscitation consider Amiodarone 5mg/kg iv and iv 20% lipid emulsion (1ml/kg over 1min times 3 then an infusion 0.25ml/kg/min).
What could you consider doing a "Serratus anterior plane" nerve block for in the ED?
It can be a very effective block, allowing the patient with fractured anterior or lateral ribs to take fuller breaths, clear sputum and decrease narcotic requirements. Below is a link showing briefly how it is performed.
Which of the following would a supraorbital nerve block be suitable for?
The supraorbital nerve is easy to block as it comes out of the supraorbital notch. It supplies the sensation to the forehead, scalp and upper eyelid. Below is a link showing it being performed.
What of the following is NOT an advantage of the fascia iliaca block over the femoral nerve block.
The femoral nerve block covers the front of the thigh and the knee. The fascia iliaca block covers the front and lateral thigh as well as the hip joint. Below is a link to a "Core EM" demonstation of the technique.
Which would be the most appropriate nerve block to use for a laceration over the cheek?
The infraorbital nerve comes out of the infraorbital foramen and can be blocked via an intra oral or extra oral route. It is great for upper lip and cheek lacerations. Below is a link showing an intra oral approach.
What is the maximum dose of Bupivicaine 0.25% you can use in a nerve block for a 70kg patient?
It can be confusing. In reality you use far less than the maximum dose in practise.
In 1903 Heinrich Braun added Adrenaline to local anaesthetics to increase the time they worked. What was it nicknamed?
Additon: Halstead and his colleagues in the late 1880s injected each others nerve trunks with cocaine to test the effects. As a result Halstead and a number of his assistants developed life ruining cocaine addictions.