I have seen Bier blocks used without problems. However the literature on npo status is also replete with support for sedating without concern for when the kid ate. I think sedating with ketamine, versed and fentanyl is very different than GA and so is the risk of aspiration. Be cautious about the bier blocks bc of the low therapeutic index and risk of cuff failure. Alternative like an ancillary block or hematoma block are also viable options
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> On Oct 9, 2013, at 6:42 AM, "Mike South" <[log in to unmask]> wrote:
> This is our Clinical Practice Guideline for Biers Block
> Prof Mike South
> Paediatrician & Intensivist,
> Chief Medical Information Officer
> Professor, University of Melbourne
> Director, Department of General Medicine
> Honorary Fellow, Murdoch Childrens Research Institute
> The Royal Children's Hospital Melbourne
> 3 West Clinical Offices | 50 Flemington Road | Parkville | 3052 | VIC
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> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Musab Yahia
> Sent: Wednesday, 9 October 2013 3:29 PM
> To: [log in to unmask]
> Subject: Bier Block
> Hi Everyone!
> I wanted to get input from anyone who's had experience using Bier blocks for fracture reductions. I've had several cases in the past couple of weeks where kids sustained a distal upper extremity fracture (which require reduction) and ate something shortly prior to ED arrival. Moderate sedation isnt an option and getting into the OR within a reasonable time frame isn't possible.
> 1. Is the Bier block practical for use in the ED? When used, how long after do you monitor the patient for?
> 2. Would you prefer it in fracture reductions versus if moderate sedation was an option?
> 3. Other than the potential of lidocaine causing an arrhythmia if improperly done, what complications have you seen from the Bier block?
> Any input is appreciated.
> Musab Al-Yahia, MD
> Gulf Coast Medical Center Emergency Room Panama City, Florida
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> The URL for the PED-EM-L Web Page is:
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