The other thing (apart from ketamine) that always crops up at this time of year is
colles' management. I know its been covered at length before, but without any
particular consensus. I'm prompted to raise it again because our overstretched
anaesthetic department has made it perfectly clear that they no longer want to
Bier's block A&E patients in A&E. They suggest doing them in main theatres
(geographically remote from A&E). The orthopods are totally did-interested in
tweaking the wrists "for us" in main theatre. The choices are:
1) Mid/senior grade A&E docs do the Bier's. This requires 30-45 minutes of senior
doc time tied to one patient and the RC of Anaesthetists discourage use of Bier's
by non-anaesthetists in non-anaesthetic areas.
2) Logistic nightmare of getting patient to main theatre (booking slips, trauma
lists, negotiating ith other specialities, negotiating with theatre manager /
recovery nurses / porters etc.) then A&E doc has to leave A&E, don greens, tweak
wrist, wait for repeat XR, un-don greens and return to A&E.
3) non-Biers technique in A&E by A&E staff (haematoma block, axillary block,
midazolam/nitrous, ketamine, acupuncture, hypnosis).
Questions:
What do YOU do now?
How would you like YOUR colle's to be numbed pre-tweak?
Gautam
Dr G Ray
Staff Grade
A&E
Sussex
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