Now, what's all this about check x-raying while they're still blocked? I 
mean, if you've had one really good go at it (as you do with Bier's :-) then 
there's no point in having another go following the check x-ray, is there? 
I'd say 99% of them will be just fine after one go, but if it's not OK then 
there's no way you'll improve it by doing it all over again; better let 
orthopods fix it under image intensifier and using k-wires or ex-fix to 
stabilise etc.

AF


----- Original Message ----- 
From: "Doc Holiday" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, December 22, 2009 8:10 PM
Subject: Re: Haematoma blocks



From: [log in to unmask]
> I think someone said they were using 7-8 ml of 2% lignocaine



--> Someone did... Sort of...



> Surely that runs a risk of toxicity, doesn't it?



--> Not really.

Toxic threshold is stated at 3mg/Kg

Let's take a "dangerous patient" - say weight is 50Kg (which it generally 
isn't, but let's do worst case...)

So you'd think a max of 150mg, which is 7.5ml of 2%...

And that sounds a tad borderline, I know, especially if you add a bit for 
the ulnar styloid...



But then, I did not say "2% lignocaine". I said "2% lignocaine with epi"... 
Toxicity at about 6-7ml/Kg... Aven if it's 6, a person would have to be 
under 35Kg for 10ml to be toxic...



If you really think you're only going to need one pull or you are certain 
you can pull and then immediately image by walking the patient around to ED 
Xray (I've done this often), then go for 1% and relax...



> I've certainly seem some haematoma patients complain of peri-oral 
> paraesthesia



--> I have not.



> ...even in our worst days we've always managed to push everyone through a 
> single room, with a single operator with his single cuff



--> Sounds OK by me. If that's what you do - fine.

We do not move the patient to any particular room - we do it in whichever 
room the patient is. Saves time, hassle and cleaning...

And we're a big place, with lots of juniors who want to learn - why not have 
one senior supervising 2-3 of them in quick succession, if that's what 
happens... Each to their own way... It's not really about speed...



> So I don't ask about handedness either - well I don't record it...



--> With very few exceptions, I also no longer ask about handedness and have 
not since when I was an SHO in plastics and hands surgery in South Africa.



BTW, I did a bit of shopping today and was out and about in town and I must 
admit that I nearly fell over about 6-7 times in a half-mile walk... Very 
slippery...



Be careful out there...



Especially you older ones... ;-)

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