winter’s wrap 27.09.2017 – Fascia Iliaca block, pneumothorax

Fascia-Iliaca Block – Dr Liz Wyatt

remember your anatomy! use anatomical landmarks then confirm with US…identify vessels, move laterally, identify iliacus muscle and position needle deep to fascia lata

volume is the key! Ropicavaine 1-3mg/kg diluted to 40ml with N/Saline

document local anaesthetic, dose and time in notes and on medication chart

see Liz’s presentation here

Pneumothorax – Dr SzeChi Freidanck

British Thoracic Society Guidelines – small < 2cm at hilum

Western Health Respiratory and Thoracics Units Guidelines:

1)      Large pneumothorax which is chosen to be treated conservatively (asymptomatic patient)  and for primary VATS must be discussed with the Thoracic Registrar/Consultant and booked into their clinic for review in 1 week

2)      Conservative treatment (small/moderate) asymptomatic : a period of observation in EOU then followed by repeat X-ray prior to D/C is a safe plan: Respiratory Clinic follow up

3)      Symptomatic patients should have an intervention: small bore catheters/Pig tail catheters: acceptable choice

4)      Complications following intervention should be looked for :bleeding/catheter blockage, and transfer patients are at risk of complications (Footscray remains the preferred destination for any patient with ICC/catheter)

5)      Complete/Total lung collapse/Radiological signs of Tension Pneumothorax = prompt intervention= ICC

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