In message <[log in to unmask]>, Rowland Cottingham
<[log in to unmask]> writes
>In-Reply-To: <[log in to unmask]>
>I never had an axillary block work in my hands - yes, never!
We do very few axillaries, but they have their place (e.g. when, as
Ffion says, its icy outside and you've got a queue of colle's to tweak).
Selecting your patients helps, especially if you're and "occasional"
blocker: no point with the large, amorphous old ducks with barely
palpable arteries buried under folds of atrophic redundant axillary
skin: waste of time unless you can afford a Stimuplex and the needles to
go with it.
My first axillary block (under the expert tuition of Dr Gardner - lend
us a fiver, Boss!) worked a dream - in a healthy, skinny, youngish
bloke. Since then, less practice and of course, less success. Major
advantages of axillary over biers:
don't have to be starved (?),
don't need gasboard (often hours delay),
post-MUA comfort for patient and
less medical / nursing time required.
Like Mr. Cottingham, we consider Bier's (+/- second tourniquet to give
"combined haematoma block") the preferred method, as it is 100% (yes,
really) reliable. Also seems to be 100% safe, so far (5 years, ?500
Bier's in this A&E). We prefer the anaesthetists to come and do it (to
leave us free), but regularly do them ourselves (all senior/mid grades
here anaesthetic-trained) if sufficient cover in department to allow one
of us to be tied up for 30 minutes, and unacceptable delays waiting for
anaethetists. Our anaesthetists support but don't exactly encourage
this.
===========================================================================
Goat
(e-mail: [log in to unmask])
Sussex, U.K.
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To err is human, to forgive is not management policy
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