Wednesday Wrap-up: 5/23/12

Time:	Speaker:	Lecture:
8-8:50	Nadir	Debriefing
9 -9:50	Adeleke	Hypersensitivity Derm Disorders
10 -10:50	Ritchie / Christopher	Facial blocks / Sinusitis
11 -11:50	Julie / Jegede / Christopher / Caputo	Pearls

It seemed like the popular topic of conference this week was facial blocks. It is a practical and useful skill to have in any ED but especially if you do not have dental / OMFS on call. I personally do not have that much experience but after the lectures by Dr. Ritchie and Caputo, I will be looking to do more. Let’s go over them:

General advice given:

Use bupivicaine for dental blocks for longer pain control.

Use small needles: 25 gauge

Offer this to your patients with dental pain instead of opioids but will last only 3-4 hours.

Subperiosteal: This is a localized block for a single tooth. Only useful for isolated injuries. I think of it as a digital block for a tooth. Inject at muccobuccal fold and aim towards the apex of the tooth. Hit bone and withdraw slightly then inject.

Inf alveolar : Provides anesthesia to the unilateral manidulbular teeth, body of the mandible, unilateral tongue and the unilateral mental nerve distribution. Approach is from the opposite side of the mouth lined up with the unilateral mandibular teeth. Use non injecting hand to palpate the coronoid process of the mandible and move soft tissue out of the way. Injection site is at the intersection of the pterygomandibular raphe and imaginary line from coronoid process (see pictures in article). You are aiming for the bone of the mandibular sulcus, then withdraw and inject.

Infraorbital block: Provides anesthesia to the unilateral lower eyelid, lateral nose, medial cheek, upper lip, incisors, canine, premolars. The infraorbital foramen is lcm below the inferior orbital rim. The approach is from the muccobuccal fold at the unilateral first premolar aiming toward the foramen. During injection have you non injecting index finger palpating the foramen for reference. When the needle is at the roof of the foramen inject.

Mental block: Provides anesthesia to the unilateral chin, lip and biccal mucosa. Injection site is the mucobuccal fold between the mandibular first and second premolars. Aim towards the mandible while advancing towards the mental foramen with your non injecting index find palpating. When you reach the foramen withdraw slightly and inject.

These are some of the high yield blocks. I urge you to check out the EB medicine article: Fixing Faces Painlessly for pictures and other blocks. Tell me what you think and your experiences with these blocks.

I also thought Dr. Nadir’s lecture on debriefing was very interesting. How practical does everyone think this is in a busy ER, do you think it will be helpful for you? Seniors and attendings are there any techniques you would to share with everyone that you have used in the past?