I meant axillary block ( auto correct slipped that one by me!)
So if the kid had a small meal or a light meal and the fracture needed reduction, I do sedate . Sometimes I'll pretreat with zantac to reduce stomach acid and may also give 1 ounce Mylanta about an hour before the procedure.
I would also argue that if the sedation doesn't seem safe, it is perfectly reasonable to splint in apposition of comfort and have the child return in the next couple of days ( preferably first thing in the AM) for a reduction. afterall there is no need to reduce a fracture acutely unless there is NV or skin compromise
Martin Herman, M.D.
Pediatric Emergency Medicine
Sacred Heart Children's Hospital
Florida State University, Department of Pediatrics
5153 N. 9th Ave, 6th Floor Nemours Bldg
Pensacola, FL 32504
Ph: 850 416 7658(office)
Email: [log in to unmask]
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> Date: Wed, 9 Oct 2013 12:09:07 -0500
> From: [log in to unmask]
> Subject: Re: Bier Block
> To: [log in to unmask]
> 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
> Dr herman
> Sent from my iPhone
> > On Oct 9, 2013, at 6:42 AM, "Mike South" <[log in to unmask]> wrote:
> > This is our Clinical Practice Guideline for Biers Block
> > http://www.rch.org.au/clinicalguide/guideline_index/Biers_Block/
> > Cheers
> > Mike
> > 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
> > T 03 9345 5182 | E [log in to unmask] | F 03 9345 4751 | W www.rch.org.au/genmed
> > -----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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