Let’s Get Started
To start, watch the Introduction to Nerve Blocks at DEM Video by our own ‘Block Bro’, Dr. Matthew Vandehei
Finished?
ED Faculty: E-mail Matt Vandehei your self-classification and next steps for getting signed off
Evaluations
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Which blocks are we doing?
Hip Fractures
Indications
- Hip/proximal femur fractures
Contraindications
- Concern for neurovascular injury
- Open fracture
- Cellulitis over block site
- Severe distortion of anatomy/tissue
- Pregnancy
- Ipsilateral fracture at risk of compartment syndrome (e.g., concurrent tib/fib fracture)
- Anticoagulation (relative contraindication)
Fascia Iliaca Block
Evaluations
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Additional References
Rib Fractures
Indications
- One or more rib fractures with severe pain
- Chest tube thoracostomy with severe pain
Contraindications
- Anticipated admit to trauma surgery
- Concern for neurovascular injury
- Open fracture
- Cellulitis over block site
- Severe distortion of anatomy/tissue
- Pregnancy
- Anticoagulation (relative contraindications)
Erector Spinae Block
Evaluations
Like what you see? Tell us! Leave us an evaluation HERE
Additional References
Frequently Asked Questions
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Remind me... why are we doing this?
A few reasons…:
- Ultrasound-guided nerve blocks (USNBs) reduce opioids use and provide more effect analgesia to acutely injured patients
- USNBs have been shown to improve outcomes in elderly patients with hip fractures
- We (Emergency Medicine) are in-house 24/7/365 to perform UGNBs for acutely-injured patients.
Which apps can I use to calculate dosages of anesthetics?
SafeLocal is a free app available available on iOS and Android to assist with calculations of anesthetic doses. MDCalc can also be used.
Where can I find the order panel?
The order panel is titled ‘Nerve Block- ADULT.’ It is located on the ED Quicklists under the ‘Chief Complaints’ panel. This order panel has specific orders for cardiac monitoring, measuring weight, and nursing assessments for LAST.
Where can I find the supplies for a nerve block?
Find the Block Box! These have all of the supplies needed to complete a nerve block in the ED (except for the anesthetic). This is located on the Suture Cart in the UH ED and on the Ortho/Splint Cart in the EMH ED.
How do I document a nerve block in the patient chart?
In the ED Navigator, click ‘Procedures’. Use the Notewriter and search for ‘Nerve Block.’
This pulls up the Nerve Block Note Template. It is very important to fill out the anesthetic utilized the the given volume, in the event the patient needs a repeat block downstream.
What are the signs and symptoms of LAST?
Remember, LAST is RARE (~1/1,000 cases). Symptoms include:
- Early: perioral numbness/tingling, metallic taste, tinnitus, lightheadedness, auditory/visual disturbance, muscle twitching.
- Late: CNS depression, seizure, cardiac arrhythmias (e.g., bradycardia, asystole).
How do I treat LAST?
Treatment is intralipid. This should be brought to the bedside prior to the start of the procedure by the ED RN. It is located in the UH ED South Side Accudose, and the EMH ED Pod 5 Omnicell.
- Start with a bolus (1.5cc/kg) (~100mL for a 70kg pt)
- Following this, begin an intralipid infusion
- Consult with your friendly ED Pharmacist for additional questions!
See this great infographic from ASPA for more information!
How do I get 'signed off', so I can start doing ED Nerve Blocks?
There are three training pathways:
- “I have experience and am comfortable with blocks.” –> watch the ‘Introduction to Nerve Blocks’ Madtown Sono training video above. e-mail Matt VandeHei when completed.
- “I am interested in learning how to do these, but need some help and dedicated training.” –> Attend ACES and/or sign up for a training session with Matt VandeHei. e-mail Matt VandeHei to set this up.
- “I’m not interested (yet).” –> let us know, and e-mail Matt VandeHei when interested.