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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)! Phil. -----Original Message----- From: Rowley Cottingham [mailto:[log in to unmask]] Sent: 10 December 2004 10:44 To: [log in to unmask] Subject: Re: Bilateral Colles Fractures Wow, there's some serious polypharmacy! I used to do these many years ago using diazepam 15mg. 10mg and they remembered it 20mg and they stopped breathing. I still find diazepam easier to titrate in the elderly than midazolam. I cannot see any justification for this. Ketamine only with perhaps some bzp as they wake if there is evidence of emergence phenomena or bzp and morphine alone. The safe dose of plain lidocaine is 3mg/kg, so Phil's haematoma block regime is perfectly safe down to a 34kg patient. Best wishes<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> Rowley. -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of John Chambers Sent: 09 December 2004 23:31 To: [log in to unmask] Subject: Re: Bilateral Colles Fractures sorry a bit late on this one but we would have reduced them under sedation 1 mg midazolam 2 mg morphine 20 mg ketamine would work a treat in this lady when she woke up would admit to the medical ward Bilateral haematoma blocks indeed, bet they did not work Johnc -----Original Message----- From: Accident and Emergency Academic List [mailto:[log in to unmask]]On Behalf Of John Ryan Sent: Friday, December 10, 2004 12:24 PM To: [log in to unmask] Subject: Re: Bilateral Colles Fractures Simon, Surely you should not lose sight of the patient here at the expense of the 'disorder'. Why does she need manipulation ? WiIl she still be alive by the time they have healed. What is your aim ? Surely at 99 it is to achive function and comfort. Yeah, maybe she is living alone independently, carrying all her own shopping home at 99 in sunny Bournemouth Simon but I supsect she already has some other support. I am sure the suggested management here is ageist, but I am not so sure it is wrong, I guess it is just pragmatic. Maybe the treatment might be diffreent for another age group Is not the issue here : To cure sometimes, to relieve often, to comfort always ? John Ryan ----- Original Message ----- From: Bell, Simon <mailto:[log in to unmask]> To: [log in to unmask] <mailto:[log in to unmask]> Sent: Thursday, December 09, 2004 4:48 PM Subject: Bilateral Colles Fractures I would like to pose the following scenario : 99 yr old lady with a mechanical fall has bilateral colles #'s both requiring manipulation. We as a department referred for admission and manipulation in theatre (not necessarily GA) under the orthopaedic team, met great resistance at senior level who felt a bilateral haematoma block should be done in A+E. In the end, the lady was admitted and had bilateral haematoma blocks in theatre.... It has caused a little unrest and the issues is still not resolved. we feel bilateral haematomas blocks are unsafe and the lady needs to come in anyway as she wont be able to mobilise...... I would be interested in hearing peoples opinion on safety of the procedure and effects on theatre time etc... Thanks S Bell DISCLAIMER: This e-mail and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. Any views or opinions expressed are those of the author and do not represent the views of Poole Hospital NHS Trust unless otherwise explicitly stated. The information contained in this e-mail may be subject to public disclosure under the Freedom of Information Act 2000. Unless the Information is legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed. _____ Attention: This e-mail is privileged and confidential. If you are not the intended recipient please delete the message and notify the sender. Any views or opinions presented are solely those of the author. _____