By Zachary Grambos, MD
Welcome back to your ACEP Ultrasound Newsletter! The FOAM community is continuing to grow and change, and we have a great new resource for the beginning of 2017. Check out Dr. Andrew Herring’s brainchild, the Highland EM Ultrasound Pain Management website. We know that standard practices for pain management and anesthesia leave many of us and our patients wanting. Nerve blocks have become more popular recently and give us an opportunity to provide excellent anesthesia with low complication rates. Ultrasound is just the icing on the top!
For the novice, this free website provides guidance for what needle to use and advice on anesthetic choices (Image 1). There are also guidelines on when blocks are appropriate or not or when to call first (Image 2). Not only does the website feature “bread and butter” blocks, like those for extremities/shoulders/fingers, it also encompasses techniques which may be foreign to even a seasoned EM provider.
Dr. Herring also encourages you to check out the RAPTIR block. Besides having a name that harkens back to the 1993 classic, it also appears to be a nerve block that provides extensive upper extremity anesthesia with less risk of diaphragm paralysis, less patient discomfort, and easily imaged landmarks (Images 3 and 4).