Block Evaluation 3
WELCOME BACK! I have made a number of observations and recognized a number of patterns over the last several years working with nerve block patients. Here’s another I’d like to share. A point that I’ve made a dozen times in lecturing is that as you change or add techniques or processes, do so.. read more →
Ultrasound Tip #2
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Block Evaluation 2
DON’T MUDDY THE WATER So, here you are in the PACU with a patient that just had a big surgery. The nurse called you here because the patient is hurting (“and I’m not sure your block is working, Doctor”). The patient is ‘mostly’ alert and says that they are hurting “over there”, pointing vaguely.. read more →
PACU Bypass
I have recently been inspired by one of my fantastic CRNA’s, Ashley Hayes, to begin bypassing the PACU, and it is kind of addicting, I have to say. I’ll go on record as saying that I know I broke one of my own rules of building up and preparing infrastructure in doing this, but.. read more →
Use a Longer Needle
I discussed in a previous Tip of the Week about some of the advantages of using a larger gauge needle, and today I would like to discuss advantages of using a longer needle to improve your success. I encounter commonly the view, not put into words exactly, but expressed in behavior and choice, that.. read more →
Leaking Catheters
LEAKING IS NOT NORMAL OR REASONABLE I have talked with many people who do blocks -and some who do LOTS of blocks that are not bothered by leaking peripheral nerve catheters. “They just leak” is what they say like it doesn’t matter really and it can’t be helped anyway. Some (forgive my directness) don’t.. read more →
Exit Strategy
As I talk with ‘happily surprised’ patients post-operatively on rounds or on telephone calls, sometimes they transition to what appears to be fear and dread. It is when they go from how they feel now to what they will feel later when the peripheral nerve block catheter is pulled. Many patients go home with.. read more →
Block Evaluation
TAKE TIME TO LOOK BEFORE YOU LEAP Beyond visualizing a successful block on ultrasound, I usually will want to see an immediate effect of my local by asking the patient to raise their arm toward the ceiling (deltoids, C5 for an ISB) or extend their knee (for a femoral block). There are reasons why.. read more →
Safety
ANOTHER ARROW IN THE QUIVER I was happy to receive a round of texts this morning from a good friend of mine about a case that he had just performed. My friend, Dr Chip Criswell, has become quite proficient at performing ultrasound-guided nerve blocks, and I could brag about him and about other cases.. read more →
Infrastructure
THE CART AND THE HORSE Improving your nerve block program will come in the form of learning or improving technical skills or from organization of your infrastructure. I commonly emphasize in my lectures about the habit that most people have of focusing primarily or exclusively on learning technical skills in order to build their.. read more →