07-17-2004, 14:35
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#1
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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Hand trauma review
Some quick anatomy review questions... scenario on trauma eval to the area will follow. 
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.
Last edited by Sacamuelas; 07-17-2004 at 16:21.
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Sacamuelas is offline
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07-17-2004, 14:55
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#2
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Quiet Professional
Join Date: Jan 2004
Location: OCONUS...again
Posts: 4,702
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1. Ulnar
2. Median
3. Radial
__________________
“It is better to have sheep led by a lion than lions led by a sheep.”
-DE OPPRESSO LIBER-
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Guy is offline
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07-17-2004, 15:26
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#3
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Bladesmith to the Quiet Professionals
Join Date: Feb 2004
Location: Oregon, Land of the Silver Grey Sunsets
Posts: 3,879
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now you guys are running knife shop info. I'm paying attention.
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Bill Harsey is offline
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07-17-2004, 16:29
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#4
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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Some very basic upper extremity anatomy for evaluating trauma to blood vessels/nerves based on the "location" of the injury.
Last edited by Sacamuelas; 07-17-2004 at 19:49.
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Sacamuelas is offline
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07-17-2004, 21:29
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#5
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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vasculature...
Last edited by Sacamuelas; 07-17-2004 at 21:32.
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Sacamuelas is offline
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07-20-2004, 04:58
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#6
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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hand anatomy
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
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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07-20-2004, 06:42
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#7
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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EXCELLENT Sir. 
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Sacamuelas is offline
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07-20-2004, 09:38
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#8
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Bladesmith to the Quiet Professionals
Join Date: Feb 2004
Location: Oregon, Land of the Silver Grey Sunsets
Posts: 3,879
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swatsurgeon, I've had blocks done a couple times, there is no more complete pain blocking than that.
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Bill Harsey is offline
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07-20-2004, 11:43
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#9
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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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
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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07-23-2004, 08:05
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#10
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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hand nerve blocks
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  p478-482
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.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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07-23-2004, 08:18
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#11
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Bladesmith to the Quiet Professionals
Join Date: Feb 2004
Location: Oregon, Land of the Silver Grey Sunsets
Posts: 3,879
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Quote:
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
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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.
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Bill Harsey is offline
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