Today's ultrasound lecture by @mtabbut about ultrasound guided nerve blocks. #metroEUS #FOAMed #FOAMus #MedTwitter #POCUS @SLWerner_EM @DianeGramer @RJonesSonoEM @MetroHealth_EM Image
Nerve blocks allow for the management of acute pain or painful procedures in the ED. Decreases need for opiates and sedations. Ultrasound guided vs blind decreases inadvertent vascular or nerve injection and allows targeted depot of anesthetic agent around the nerve. ImageImageImage
Multiple studies demonstrate the efficacy of ultrasound guidance over landmark guidance. ImageImageImage
Characteristic appearance of a nerve = hyperechoic, honeycomb appearance, often triangular, may demonstrate anisotropy. Image
Indicated for acute pain management and acutely painful procedures. ImageImageImage
Anesthetic agents work by blocking Na+ channels thereby preventing action potentials from generating a depolarization. Image
Various agents will have different duration of actions and doses. Need to know the max dose. Lidocaine = 4.5mg/kg, Bupivocaine = 2 mg/kg. Determine your dose then dilute to reach the volume you need. Image
Toxicity = Neuro and Cardiac. Think about what preventing depolarization of respective nerves will do. ImageImageImage
ImageImage
Ulnar Nerve Block ImageImageImage
Median Nerve Block ImageImageImage
Radial Nerve Block ImageImageImage

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More from @MH_EMultrasound

Feb 10
Today's #POCUS lecture by @mtabbut about the FAST exam in Hemodynamically Pediatric Blunt Abdominal Trauma. #MetroEUS
Aggregate sensitivity of FAST for all intra-abdominal injuries is low. Specificity is high. Remember though, the FAST was designed to look for FF, not all injuries. So if the injury is not associated with FF, the FAST will likely not see it.
So what can we do to increase the sensitivity of the FAST? Serial exams and adjunctive labs.
Read 6 tweets
May 28, 2021
Patient with epig pain and multiple ED visits with neg CT and non-specific labs - but persistent pain. What do you do? GI cocktail + famotidine and discharge? How about a little #POCUS first. #FOAMed #FOAMus #Ultrasound #MedTwitter @mtabbut @laurarbrownmd @RJonesSonoEM
And the transverse view. What do you think now? Poll below in thread. #Whatsthedx #EmergencyMedicine @DianeGramer @SLWerner_EM @ClaridgeJeffrey @vanessapho @ladha_prerna
What do you think?
Read 9 tweets
Mar 11, 2021
Goal and benefit of POCUS is to rapidly narrow the differential diagnosis through asking and answering defined clinical questions.
POCUS will narrow the differential more rapidly
Read 18 tweets
Mar 10, 2021
Patient with hx ESRD on dialysis and multiple previous central catheters. Needs central line. #POCUS as shown. Go ahead and place the line? Poll in thread. #FOAMed #FOAMus #MedTwitter #EmergencyMedicine @mtabbut @RJonesSonoEM @SLWerner_EM @NephroP @siddharth_dugar
Place the line here?
Answer: This patient with chronic thrombus at the shown location. Best to look for a different location.
Read 4 tweets

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