----- Original Message -----
From: RAY McGLONE
> We've been doing Bier's blocks for reduction of Colle's fractures in A&E
at
> Lancaster for over a decade without any problems. SHO and a nurse are
needed
> only (once the SHO has been trained). If a check X ray is not being done
> then the cuff can be let down at 20 mins.
> The anaesthetists in our hospital have less experience than us in doing
> Bier's blocks.
> Bier's blocks are extremely safe!
>
> Ray McGlone
> A&E Lancaster
I agree, though I'm perhaps even more reductionist in my approach. I too
carry out Bier's blocks accompanied only by a nurse though sometimes with an
SHO for education and countertraction! I no longer "electronically" monitor
these patients as toxicity is a clinical diagnosis, though I have immediate
access to resus equipment if the need ever arises. I no longer gain i.v.
access in the other arm - I have only ever seen toxicity from haematoma
blocks and these patients don't get i.v.access pre-procedure. I let the cuff
down at 15 minutes - even the RCAnaes say that's OK! However I don't let our
SHOs do Bier's blocks, perhaps I should...
I have my own set of contraindications:
1 The patient must have a suitable vein distal to the fracture site
2 The patient mustn't be hypertensive
3 The patient mustn't be disturbed or in any way mentally unstable
These contraindications are not found in standard textbooks, which mention
largely irrelevant things such as local infection (never seen that related
to a colles fracture), sickle cell anaemia (despite my ethnically diverse
patient group, I've yet to see a colles fracture in an AfroCaribbean
patient) and epilepsy (has never stopped me from doing a Bier's block).
These textbooks have of course been written by anaesthetists and
pharmacologists, none of whom actually do Bier's blocks in the real world!
Lecture over...
Adrian Fogarty
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