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Paul, You are indeed fortunate in your department! We only see our anaesthetists for severely ill/injured patients requiring resus (and very good they are to). They backed out of providing services like Bier's block years ago, although, interestingly, they still state that such procedures should only be done by anaesthetists! It does make a great difference when they are available - in one hospital in which I worked, they were scheduled to be available twice a day to provide such services, and GAs, which simplified matters enormously, and saved a lot of A&E man-hours. Phil. -----Original Message----- From: Howarth, Paul - RCHT [mailto:[log in to unmask]] Sent: 01 October 2002 10:25 To: [log in to unmask] Subject: Re: Bier's Block We have people called anaesthetists in our hospital, they outnumber us by about 20 to 1. They seem to like to come down to the department to ply their trade (which they seem to do quite well), they also bring down an ODP with them so who checks the equipment and drugs, so all our nurses have to do is assist us in putting on the plaster. It means that we are free to concentrate on doing the manipulation and then getting on with other things. Paul -----Original Message----- From: Adrian Fogarty [mailto:[log in to unmask]] Sent: Tuesday, October 01, 2002 02:40 To: [log in to unmask] Subject: Re: Bier's Block A lot of issues coming up here! Firstly with respect to haematoma blocks, I'm not convinced these can be done much faster than a Bier's; I do a Bier's in less than 20 minutes, all in, with a cuff time of 15 minutes. Secondly I find many fractures are too impacted to allow easy access for a haematoma block, or conversely so markedly displaced that I don't believe a local injection can effectively anaesthetise them. Thirdly the only time I've seen toxicity (mild) was with a haematoma block - well you are injecting local into a vascular marrow cavity, aren't you! I still do the occasional haematoma block however, if the patient is older (less vascular bone) and if the fracture is suitable (can get my needle into it easily, and which doesn't require much manipulation). I still don't get the analgesia that I get with Bier's however (i.e. complete block). But perhaps my haematoma technique isn't as good as it could be, so I'd be grateful if someone (perhaps John Black) could enlighten me on their technique, including doses, injection site and timing etc. Adrian Fogarty ---------------------------------------------------------------------------- ------------------------ The information in this e-mail and any attachments is confidential and is intended for the attention and use of the named addressee(s). It must not be disclosed to any other person without our authority. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient or are aware that this e-mail has been sent to you in error, you are not authorised to and must not disclose, copy, distribute, or retain this message or any part of it. We sweep all outgoing mail for the presence of computer viruses. However we cannot accept any responsibility for any loss or damage to your systems due to viruses or malicious code not detected. The statements and opinions expressed in this message are those of the author and do not necessarily reflect those of the organisations within the Cornwall & Isles of Scilly Health Community, which will not automatically take any responsibility for the views of the author. ---------------------------------------------------------------------------- -----------------------