Some of our docs "like" doing a hematoma block and "feel comfortable" about
the technique but most of the patients seem to wince a fair bit!!
My memory of Bier's blocks is a bit historical perhaps I did over state the
failure/discomfort rate
Perhaps I am just a midazolam junkie (giving it not taking it!)
JohnC
-----Original Message-----
From: Robert Anthony COCKS [mailto:[log in to unmask]]
Sent: Friday, 25 February 2000 18:19
To: [log in to unmask]
Cc: 'acad-ae-med'
Subject: RE: Bier's Block
John
I'm puzzled by your mention of a high failure rate. I haven't personally
done any Biers since I've been in HK, but when I routinely used the
technique during winter "Colles season" in the UK, I didn't encounter any
which failed to work out of well over 100 done. There were some where I
failed to find a vein to set up the block in the first place, but using
30-50ml of 1% Prilocaine was always reliable once in. Perhaps I was using a
lot.......?
One useful tip for finding veins for Biers (can't remember the origin now,
but I think one of our A&E colleagues wrote it up in the old BJAEM) is to
cannulate a thready vein on the back of the hand with a tiny butterfly.
Inflate the cuff, then inject 50ml of Saline into the venous system. It
pumps up the bigger veins nicely so they can be cannulated more easily.
I've always hated haematoma blocks because they often don't work well (in my
hands anyway - perhaps others do better !) and your "ouch" scenario seems
more familiar when using those.
Cheers,
Rob Cocks HK
BM__MailData-----Original Message-----
From: John Chambers [ mailto:[log in to unmask]
<mailto:[log in to unmask]> ]
Sent: Friday, February 25, 2000 6:31 AM
To: [log in to unmask]
Subject: Bier's Block
Bier's Block is obviously safe
Just a shame it has such a high failure rate
To quote many a silly young doctor when the patient screams as their broken
wrist is pulled and waggled "Did you feel that?....."
Analgesia +Midazolam (followed by Flumazenil) rules OK
They feel it but they don't give a damn!
JohnC
-----Original Message-----
From: Andres Izquierdo Martin [ mailto:[log in to unmask]
<mailto:[log in to unmask]> ]
Sent: Thursday, 24 February 2000 11:16
To: Emergency List
Subject: Re: VT and acidosis
----- Original Message -----
From: Doc Holiday <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, February 23, 2000 12:37 AM
Subject: Re: VT and acidosis
> Definition: Bier's Block
>
> A method for inducing arrhythmias in a patient who is "on no medication,
had
> no prior history of heart disease, and who had a normal pre-op ECG."
>
> Can't think of any other indications...
No much imagination if you cannot think of any other indications.
Bier's Block is a safe and useful technique to use in an emergency
department.
If you check the literature you will find many papers comparing favourably,
Bier's Block with haematoma block.
The other possibility, of course , is general anaesthesia; but I cannot
believe you think that this option is "arrhythmia free".
I think we would all be interested to know what is your "risk
free"
option.
Andres Izquierdo Martin
SpR Emergency Medicine
Royal Free Hospital
North East Thames Region
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