Hand trauma review

[Sacamuelas]

Some quick anatomy review questions... scenario on trauma eval to the area will follow. :cool:

On this diagram.. give the name of the nerve innervating the listed areas.

1. ulnar
2. median
3. radial

edited to add correct answers from Guy.:cool:

[Guy]

1. Ulnar
2. Median
3. Radial

[Bill Harsey]

now you guys are running knife shop info. I'm paying attention.

[Sacamuelas]

Some very basic upper extremity anatomy for evaluating trauma to blood vessels/nerves based on the "location" of the injury.

[Sacamuelas]

vasculature...

[swatsurgeon]

One of the skills I like to teach is the nerve block.....if you look at the figures already presented, you see where the major nerves are in relation to the arteries. Being able to perform a good block may keep an injured fighter in the fight or at least capable of defending his/her butt and the '6' of their comrades.
I have treated and spoken to many soldiers/SEALS/SWAT personnel (notice no SF...maybe they don't get hurt..or don't admit it??), etc that do go through the adrenaline surge of no pain post injury but it doesn't last....maybe 2-5 minutes than it's a bitch of a pain (fingers or hand). This time period gives the medic an opportunity to do a digital or other nerve block. I have done it as part of my Tactical doc role with our SWAT team. I'll post the references when I dig them up later today or tomarrow. It is a procedure worth learning...can also do it to yourself if need be. I'll discuss technique, meds, equipment, and myths.

T-2

[Sacamuelas]

EXCELLENT Sir. :munchin

[Bill Harsey]

swatsurgeon, I've had blocks done a couple times, there is no more complete pain blocking than that.

[swatsurgeon]

Bill,
I have had the pleasure of amputating the tip of my ring finger on my support hand with, I'm sorry to admit it was another makers knife, the nimravus by benchmade......I was cutting a frozen milkyway for my daughter and the genius surgeon put his finger under the blade and a really clean slice through skin, tissue and bone....3-5 minutes later the pain was magnificent and I did a digital block at home then saw the hand surgeon....relief was sooooooo nice!
Doc-T should remember that little performance in Miami!!
T-2

[swatsurgeon]

as promised here are some references for performing blocks.
What do you know, the military actually had some of the best articles on this!!
1) Thompson WL (CPT), Malchow RJ (LTC). Peripheral Nerve Blocks and Anesthesia of the Hand. Military Medicine June 2002;167:pp478-482
2) Calkins MD (MAJ), et al. Pain Management in the Special Operations Environment: Regional Anesthetics. Military Medicine March 2001;166: pp211-216.
If you don't have access to this journal I would be happy to fax/send a copy to you. They have excellent descriptions of the "how to and with what" for all hand and digital blocks.

www.nda.ox.ac.uk/wfsa/html/u11/u1112_01.htm is a site for lower extremity block techniques

for teeth, lidocaine jelly/paste 2% or ambisol...just ask our dental friends on line

www.nyerrn.com/er/procedures.htm for good references on all kinds of issues

www.aorn.org/journal/homestudy/jan02a.pdf for an overview of nerve blocks (RN perspective)
hope this helps...having more than 1 way to treat everything should be everyones goal...
he who wins , in medicine, has the most techniques at their disposal.

[Bill Harsey]

Originally posted by swatsurgeon
Bill,
I have had the pleasure of amputating the tip of my ring finger on my support hand with, I'm sorry to admit it was another makers knife, the nimravus by benchmade......I was cutting a frozen milkyway for my daughter and the genius surgeon put his finger under the blade and a really clean slice through skin, tissue and bone....3-5 minutes later the pain was magnificent and I did a digital block at home then saw the hand surgeon....relief was sooooooo nice!
Doc-T should remember that little performance in Miami!!
T-2 OUCH! I think we share one little thing, if either of us have an accident with a knife this may leave us open for comments.