028: Anatomy of the fasica iliaca block

Hi Guys, sorry for the big gap in posting. Life has a way of taking over as you all know.

I’m currently trying to introduce fascia iliaca blocks as part of routine care for patients in our department so i thought a podcast on some of the anatomy wouldn’t go a miss. If you want some light reading on the literature, then I’ve included a big list below. If you’re more practically orientated then I’d strongly recommend the following:

Ultrasound Podcast: Fem Nv Block

NYSORA: Fascia Iliaca Block.

Slides are on slideshare

References:

1.Godoy Monzón D, Vazquez J, Jauregui JR, Iserson KV. Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics. Int J Emerg Med. 2010;3(4):321–5.

2.Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthopaed Traumatol. 2009 Aug 19;10(3):127–33.

3.Høgh A, Dremstrup L, Jensen SS, Lindholt J. Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture. Strat Traum Limb Recon. 2008 Sep 2;3(2):65–70.

4.Godoy Monzón D, Iserson KV, Vazquez JA. Single fascia iliaca compartment block for post-hip fracture pain relief. JEM. 2007 Apr;32(3):257–62.

5.NZ Guidelines Group. Acute Management and Immediate Rehabilitation After Hip
Fracture Amongst People Aged 65 Years and Over. 2003;:1–40.

6.National Clinical Guideline Centre. The management of hip fracture in adults. 2011;:1–664.

7.SIGN SIGN. Management of hip fracture in older people. 2009 Jun;:1–56.

8.(null) INHFDSG. Irish Hip Fracture Database Preliminary Report 2013. 2014 Mar 4;:1–50.

9.(null) TCOEM. Clinical Standards for Emergency Departments. 2013;:1–16.

10.Beaudoin FL, Haran JP, Liebmann O. A Comparison of Ultrasound-guided Three-in-one Femoral Nerve Block Versus Parenteral Opioids Alone for Analgesia in Emergency Department Patients With Hip Fractures: A Randomized Controlled Trial. Academic Emergency Medicine. 2013 Jun 12;20(6):584–91.

11.Elkhodair S, Mortazavi J, Chester A, Pereira M. Single fascia iliaca compartment block for pain relief in patients with fractured neck of femur in the emergency department: a pilot study. Eur J Emerg Med. 2011 Dec;18(6):340–3.

12.Williams R, Saha B. Best evidence topic report. Ultrasound placement of needle in three-in-one nerve block. Emergency Medicine Journal. 2006 May;23(5):401–3.

13.Christos SC, Chiampas G, Offman R, Rifenburg R. Ultrasound-guided three-in-one nerve block for femur fractures. West J Emerg Med. 2010 Sep;11(4):310–3.

14.Fletcher AK, Rigby AS, Heyes FLP. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003 Feb 1;41(2):227–33.

15.Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010 Jan;28(1):76–81.

16.Haines L, Dickman E, Ayvazyan S, Pearl M, Wu S, Rosenblum D, et al. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. JEM. 2012 Oct;43(4):692–7.

17.Rashid A, Beswick E, Galitzine S, Fitton L. Regional analgesia in the emergency department for hip fractures: survey of current UK practice and its impact on services in a teaching hospital. Emergency Medicine Journal. 2013 Jul 22.

18.Abou-Setta AM, Beaupre LA, Rashiq S, Dryden DM, Hamm MP, Sadowski CA, et al. Comparative effectiveness of pain management interventions for hip fracture: a systematic review. Ann Intern Med. 2011 Aug 16;155(4):234–45.

19.Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev. Wiley Online Library; 2002;1.

20.Foss NB, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology. 2007 Apr;106(4):773–8.

027: Basic Anatomy of Abdomen and Pelvic Trauma

This is the second part of a recent lecture I gave to some first year med students to get across how important their anatomy is to understanding trauma.

First part lives here

You may have to click through to the GMEP site to see the full HD version

PDF of slides

 

 

 

026: Basic Anatomy of Chest Trauma

This is a screencast of a recent lecture I gave to some first year med students. It’s mainly to give the students some clinical info to keep their regular anatomy teaching relevant. It’s not designed to be a comprehensive intro to trauma in any way.

It’s longer than the usual podcasts so I’ve split into two parts.

Feedback, is as always, welcome.

PDF of slides. 

025: PK SMACC talk

This one’s a little bit different. You’ve all heard of SMACC I’m sure. If not which rock where you hiding under?

It’s the the most exciting conference happening this year. All the your favourited FOAMites in one place giving it dixie on all things EM and Critical Care. There is still time to get booked in for it.

I, alas, will be holding fort on the Emerald Isle supporting the dog, wife and her ever enlarging bump and saving the spondoolies for next years SMACC (that’s happening lads isn’t it?)

They’ve put out the challenge for short, high impact teaching videos for the EM/CC community in the form of PK talks. Below is my offering. It’s a rehash of some old material but hope you like it.

024 – Shoulder: Nerve compressions

All show notes over at emergencymedicineireland.com

023 – Shoulder: Disclocations

All the show notes over at emergencymedicineireland.com

022 – Shoulder: AC and SC Joints

Continuing or walk through the shoulder joint

021 – Shoulder: subacromial space and labrum

More on our walk through the shoulder joint

020 – Shoulder: The Rotator Cuff

There is more to managing shoulder pain and injuries than just x-ray and ruling out fracture. This short podcast starts with the rotator cuff.

More info here: http://wp.me/p2GZ98-A4

019 Scaphoid Fracture

Quick and simple, likely not anything too new.

018 Scapholunate injuries

More detail on the wrist and in particular the Terry Thomas sign and carpal instability. As always there’s much more going on in the x-ray than just the bones.

Please check out radiopaedia.org.

And some cases from the podcast.

http://radiopaedia.org/cases/scapholunate-dissociation

http://radiopaedia.org/cases/scapholunate-dissociation-1

http://radiopaedia.org/cases/lunate-dislocation

The big textbook I mentioned is Clinical Sports Medicine, available here. One of the lead authors, Karim Khan is even on Twitter and worth a follow.

017 – Colles Fracture

Apologies for the sound quality on this one, not as good as it usually is. Any feedback is always appreciated.

More of the Grandma photos here.

Wheeless on Colles and EPL

016 – The LMA as a murder weapon?

OK so this one is a little bit different than the usual but still some anatomy to learn. Check out emergencymedicineireland.com for the show notes.

015 – Superior Mesenteric Artery Syndrome

Hi guys. This is yet another Zebra diagnosis but it’s a great one for illustrating some of the relevant anatomy. Let me know what you think.

Here’s the link to the article mentioned

Rudinsky, Sherri L, and Michael J Matteucci. “Emergency Department Presentation of Superior Mesenteric Artery Syndrome: Two Cases in Marine Corps Recruits..” JEM 42, no. 2 (February 2012): 155–158. PMID 19111427

014 Cavernous Sinus

Still in the skull but this time looking at the cavernous sinus.

The case report in the video can be found here

013 – Posterior Communicating Artery

Yes I know it’s more circle of willis stuff but we’re getting there I promise you.

Don’t forget to hit the HD tab if you’re watching it on the website.

Links to RootAtlas.com

And a really neat one:

012 – Posterior Cerebral Artery

Continuing where we left of. This time you’re the patient…

011 – Anterior and middle cerebral arteries

The differences between ACA and MCA strokes in terms of vascular supply to the brain

The nice little picture of the brain in the case presentation can be found here

010 – The Internal Capsule

This is key knowledge I think – if you want to understand the stroke syndromes and the different presentations then you need to understand the internal capsule and its importance

009 – Brain Herniation

This is a quick run through of the 3 main brain herniation syndromes. Enjoy

008 – Dural Venous Sinuses

 A quick run through venous drainage of the brain

007 – Cricothyroidotomy

As mentioned in the video here are some of the cric resources out there on the interweb

006.3 – Spinal Cord Injury

And the final spinal cord video, if you have the er… spine… for it…

006.2 – Spinal Cord Injury

Here’s number 2. Let me know what you think

UPDATE:

The very smart and astute Chris Nickson points out that central cord syndrome normally presents with motor weakness in the distally (in the hands) rather than proximally in the case in the video.

My bad…

He is of course right and has a nice little mnemonic for remembering it MUD: Motor/Upper/Distal

And remember that the symptoms and signs are relative not absolute:

motor>sensory
upper>lower
distal> proximal

Based on the pure anatomy – with the corticospinal tracts arranged somatotopically with the highest spinal segments most medial – one would expect proximal weakness (C5,6 etc..) more than distal (C7-8, T1 etc…). But since when does the textbook play ball with reality! Maybe it’s just representative of the level of lesion in cervical cord (ie a lower lesion when the upper segments have already exited the cord) but it has me beat. Let me know if you have a better answer

Either way the more important thing is that central cord syndrome more usually presents with distal not proximal upper limb weakness.

Kudos to Chris for spotting it.

006.1 – Spinal Cord Injury

There was just too much good stuff for one spinal cord vid so I did three. They’ll be out over the next couple of weeks