Tag: nerve block

LA – Toxicity

We are regularly doing femoral blocks next to major vessels. So warn the patient of the symptoms, & keep them monitored(at least 15 min).

Symptoms of local anaesthetic toxicity

  • Circumoral and/or tongue numbness
  • Metallic taste
  • Lightheadedness/Dizziness
  • Visual/Auditory disturbances (blurred vision/tinnitus)
  • Confused/Drowsiness/Fitting
  • Arrhythmia

Remember – Do basics WELL

  • Intralipid – in emergency drug cupboard
    • Bolus – 1.5ml/kg 20% lipid solution over 1min
    • also start Infusion – 15ml/kg/hr 20% lipid solution

PDF:la_tox

 

#NoF – Fractured Neck of Femur

Update: BOAST Guidance

If a patient with a #NoF (or other fragility fracture requiring admission) has received a head injury requiring CT a CT Neck should also be performed. A #NoF is a fragility fracture hence this patient is at high risk of also sustain C-Spine injury. Also the pain is likely distracting and the patient is often over 65yrs old so Canadian C-Spine rules will not apply.

Hx/Exam

  • Why did They Fall? – was this a collapse?
  • Are they sick? – Co-morbidity/illness is common in this group and must be recognised
  • Anticoagulants? – This affects treatment
    • On Warfarin – If INR >1.5 (or unavailable) Vit-K 5mg
  • Other injuries? – >65’s the most common mechanism of TARN major trauma is fall <2m
  • Typically – Pain hip/buttock, shortened, externally rotated
  • Atypical – Few signs (can they lift their leg & is rotation at the hip painful)