All this arguement about what we should do for the patient with a fracture
highlights the problems of guidelines ie. medics can't agree with each
other. also highlights an important principle that you should tailor an
anaesthetic to the patient depending on facilities and your own competency
in a procedure.
Tell me why you need an ODA and an anaesthetist to do a Bier's block?
Not for safety reasons...prilocaine is very safe in competent hands. Waste
more time bleeping and organising a mutually convenient time.
In Sheffield we require the presence of a competent nurse and medic
(including appropriately trained SHO's) +/- a plaster technician.
It doesn't take long to consent the patient draw up prilocaine. 10 mins to
wait for sufficent anaesthesia. Manipulate. Further 10 minutes before cuff
can be deflated. Whizz round to xray. Due to superb anaesthetic....often
no need to manipulate again. (at least not until position slips at 1 week
when seen in # clinic!, but that gives the 21 orthopaedic consultants
something to do!.
Haematoma blocks take long enough waiting 15 minutes for anaesthesia to be
sufficient....not long enough to see anybody else as the ENP's see all the
quick to see minors here!
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