Best Evidence is to use Bier's Block not Haematoma Block
http://www.bestbets.org/cgi-bin/bets.pl?record=00008
Ray McGlone
Lancaster
----- Original Message -----
From: "Niels Merkel" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, December 10, 2004 10:36 PM
Subject: Re: Bilateral Colles Fractures
> Quinton DN
> Local anaesthetic toxicity of hematoma blocks in manipulation of colle's
> fractures
> Injury (1988) 19, 239 - 240
>
> Potentially toxic levels of lidocaine were found in the arterial
> circulation, with a peak in the minutes AFTER manipulation. However,
> subjectively well-tolerated by the (small group) of patients.
>
> Regarding Benzos and Ketamine in the elderly: The main purpose of Benzos
> is
> blunting of the sympathetic outflow, and thus the cardiovascular side
> effects of Ketamine - perhaps similar to what they achieve when given in
> Cocaine intoxication.
> This combination may be justified from a cardioprotective standpoint alone
> (Steve Green) - regardless of considerations regarding ??agitation or
> ??increased muscle tone.
>
>
> This has been studied a long time ago:
>
>
> Kumar SM et. al.
> Lack of cardiovascular stimulation during endotracheal intubation in
> cardiac
> surgical patients anesthetized with diazepam-ketamine-pancuronium
> Clin Ther. 1980; 3:43-8
>
>
> Tarnow J
> [Flunitrazepam-pretreatment for prevention of adverse cardiovascular
> effects
> following ketamine].
> Anaesthesist 1979 Oct; 28(10): 468-73
>
> Erdmann W
> Antagonism of the cardiovascular effects of ketamine by diazepam in
> volunteers.
> Acta Anaesthesiol Belg 1979 Dec; 30(4): 239-45
>
>
>
> Regards,
>
> Niels Merkel
> Worthing Hospital
>
>
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC) A
> &
> E - SwarkHosp-TR
> Sent: 10 December 2004 13:16
> To: Niels Merkel
> Subject: Re: Bilateral Colles Fractures
>
>> But the safe dose assumes non intravenous injection - a
>> haematoma block is partly intravenous so the safe dose should
>> be lower (expect anti-arrhythmic effects, at least, with
>> 100mg IV in an old dear)!
>>
>
> I'm not sure that a haematoma block is partly intravenous. I know all the
> stuff about intraosseous infusion, but is there really any evidence
> (either
> a study of levels or reports of toxicity). If it is a problem, then
> leaving
> 15 minutes after the first block before you do the second one should be
> safe
> enough.
>
> Matt Dunn
>
>
>
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