Answers Scaphoid waist fracture Perilunate dislocation (transcaphoid perilunate dislocation) b) Procedural Sedation Method Biers Block Drug(s) used inc route Ketamine 0.5mg/kg repeated up Prilocaine 0.5mls/kg 0.5% solution – and dose to max 2mg/kg IV after 2 Pros Maintain airway reflexes Less risk of adverse airway events Both sedative and analgesic in Quick, with fast recovery same agent Amnestic 2 Cons Requires a resus bay and full Requires compliant patient who can monitoring/nursing input tolerate being awake during Long recovery time procedure Requires 2x IV lines 2 Complications/SE Laryngospasm LA toxicity with cardiac arrhythmias Vomiting/Aspiration and seizures Emergence phenomena Extravasation injury Hypotension if given too quickly Methhaemaglobinaemia Tachycardia and hypertension answers for sedation e.g ketofol/propofol also appropriate with suitable pros/cons/comps. Nitrous not enough for this degree of painful injury) c) uncooperative patient compromised circulation to the limb compartment syndrome in affected limb sickle cell disease fractured humerus on same side soft tissue injury at tourniquet site d) Midazolam 5mg boluses to prevent seizures/heighten seizure threshold
Answers Scaphoid waist fracture Perilunate dislocation (transcaphoid perilunate dislocation) b) Procedural Sedation Method Biers Block Drug(s) used inc route and dose Ketamine 0.5mg/kg – repeated up to max 2mg/kg Prilocaine 0.5mls/kg 0.5% solution IV after 2 Pros Maintain airway reflexes Both sedative and analgesic in same agent Amnestic Less risk of adverse airway events Quick, with fast recovery 2 Cons Requires a resus bay and full monitoring/nursing input Long recovery time Requires compliant patient who can tolerate being awake during procedure Requires 2x IV lines 2 Complications/SE Laryngospasm Vomiting/Aspiration Emergence phenomena Hypotension if given too quickly Tachycardia and hypertension LA toxicity with cardiac arrhythmias and seizures Extravasation injury Methhaemaglobinaemia answers for sedation e.g ketofol/propofol also appropriate with suitable pros/cons/comps. Nitrous not enough for this degree of painful injury) c) uncooperative patient compromised circulation to the limb compartment syndrome in affected limb sickle cell disease fractured humerus on same side soft tissue injury at tourniquet site d) Midazolam 5mg boluses to prevent seizures/heighten seizure threshold
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