RocketMedic
Californian, Lost in Texas
- 4,997
- 1,462
- 113
Did the call actually go like this? Little relief from fentanyl but great relief from a very small dose of ketamine?
Does one need ultrasound (or similar) guidance to do one?Our PA did a few in the Army. Helped me out with my finger
Does one need ultrasound (or similar) guidance to do one?
Forgot to put in the inevitable freak out from the ED because "the patient requires one-on-one care now!!!"
Nerve blocks, guys, really? Nerve blocks. Things done by specialized anesthesiologists with years of training you want to do in the field? I haven't ever seen a nerve block done even in the ER except for minor things like finder dislocations. Pain management is not as big an issue as y'all are making it out to be to need pain blocks pre-hospitally.
Oh, rubbish. Ring blocks came out two CPGs ago and there is the talk of more specialised blocks coming, particularly, but not exclusively, with ultrasound. The ED seems to like them too; for things like hands or wrists or ankles or such; I've even seen somebody have their dislocated shoulder put back in with a block and good huffings of entonox and I've heard of the HEMS Docs doing them for people with # femurs and whatnot.
Obviously not something to be done with every pt (which brings up the thorny issue of maintenance) but a selected few additional ones wouldn't be the end of the world and would be very helpful for certain patients like this one.
That's all anecdotal evidence. Sure, it can be used in select patients. But is it something that EMS providers should be providing, no. All of the fractures that you listed can be cared for/reduced perfectly fine by other means (IV analgesia/sedation) 99% of the time. I don't know about you, but I'm not reducing fractures in the field with any regularity. Even in the ED, guess what happens that 1% of the time. You pick up the phone and call someone with more training and expertise than you, whether it be the arthropod or anesthesiologist to manage the case.Oh, rubbish. Ring blocks came out two CPGs ago and there is the talk of more specialised blocks coming, particularly, but not exclusively, with ultrasound. The ED seems to like them too; for things like hands or wrists or ankles or such; I've even seen somebody have their dislocated shoulder put back in with a block and good huffings of entonox and I've heard of the HEMS Docs doing them for people with # femurs and whatnot.
Obviously not something to be done with every pt (which brings up the thorny issue of maintenance) but a selected few additional ones wouldn't be the end of the world and would be very helpful for certain patients like this one.
How have you found intravenous paracetamol? Not something I've seen.