michael kerr @mick_kerr Twitter profile

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michael kerr

@mick_kerr

2 years

Axillary brachial plexus block with some common anatomical variants in the location of the MCN and radial nerve. Very fortunate to have access to a good ultrasound, makes an enormous difference.

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michael kerr

@mick_kerr

2 months

First list in the UK... What is this horror ...

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michael kerr

@mick_kerr

1 month

Another thought from an anaesthetist from across the pond... Why on earth do trainees need to reapply to the training program? It seems obscene and cruel to force people to go through this process TWICE, and after sitting a grueling exam. Is there any legitimate reason?

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michael kerr

@mick_kerr

1 year

Anyone routinely using PNS for ultrasound guided adductor canal blocks?

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michael kerr

@mick_kerr

1 month

Week 2 in the NHS. Not a fan of inducing GA in the induction room at all... Not having an anaesthetic trolley in theatre with equipment, syringes, labels, drugs. No standardised trolley layout for commonly used meds. No red syringes for relaxants. People are nice.

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michael kerr

@mick_kerr

7 months

I think one of the easiest ways of improving in regional anaesthesia is to record your blocks. Here's a few lessons (re)learnt from a PECS2 block.

PECS2 block - Don't make this MISTAKE

This is a PECS2 block we did for mastectomy.It highlights two learning points 1. Record your blocks - and learn from them 2. You'll have to watch to find out!

www.youtube.com

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michael kerr

@mick_kerr

2 months

Sometimes you see anatomy so good that you can't help spend far far far too much time making a video on. More to follow. In the meantime... what anatomy can you see? The interscalene brachial plexus block is so much more than traffic lights.

The brachial plexus anatomy sonoanatomy - above the clavicle

The interscalene brachial plexus block is a "Plan A" block.However, the typically taught approach is fraught with danger.It's often quoted as having the high...

www.youtube.com

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michael kerr

@mick_kerr

1 year

A time and a place for everything. Usually do superficial serratus when supine. Today had a lovely lateral deep catheter. Pt did wonderfully. Fingers crossed.

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michael kerr

@mick_kerr

10 months

The popliteal sciatic block - where do you inject, and how do you get there safely? Not getting close enough = slow onset and increased failure, yet getting close = increased sphincter tone of supervisor! @ESRA_Society @ASRA_Society @RegionalAnaesUK

Popliteal Sciatic nerve block - get close safely

Popliteal sciatic blocks are a very commonly performed block.It requires a reasonably close injection of local under the paraneurium (aka circumneurium) for ...

www.youtube.com

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michael kerr

@mick_kerr

1 year

New video day. Made this as a quick tutorial for one of my previous registrars who wanted to know where I do adductor canal (more accurately apex of FT) blocks.

Adductor canal tips - Finding apex and fascial spread

Adductor canal block tips - finding the apex of the femoral triangle - decision making during needling - finding the right planes for covering the nerve to v...

www.youtube.com

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michael kerr

@mick_kerr

2 years

Fiddling with some rather easy to use tools. Pretty remarkable for free software on a mobile. @L_D_White

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michael kerr

@mick_kerr

2 months

@samuelkhanna A wobbly pressure injury device with clumsy ergonomics, zero tactile feedback for difficult veins and no flashback in the cannula...I liked the accordion thingo. It's like a little surprise for when you actually get a vein... Lol

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michael kerr

@mick_kerr

1 year

The external oblique intercostal plane block is quickly becoming one of my favourites! This was a single shot for a robot nephrectomy. Remarkable how well they can work. Looking forwards to further studies into their efficacy. @L_D_White

Quick blocks - External oblique intercostal plane block for nephrec...

This is a quick block video demonstrating a single shot EOIP block for a robot nephrectomy. Unlike lateral TAP blocks, the fascial separation is frequently q...

www.youtube.com

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michael kerr

@mick_kerr

1 year

Can you identify this novel rib technique? Couldn't have done it without the SAFIRA.

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michael kerr

@mick_kerr

1 year

@amit_pawa @DrNavSidhu @jeffgadsden @BlockIt_Hot_Pod Had tried these a while back, though inspired by the recent podcast, and been using these much more. Thanks @jeffgadsden and @amit_pawa

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michael kerr

@mick_kerr

2 months

Does the whole NHS believe that codeine is a reasonable medication? Seeing a lot of "stepping down" to codeine containing products... From small doses of oral morphine to a lucky guess at pharmacogenetics... Bizarre.

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michael kerr

@mick_kerr

1 year

Total believer in #geniculars as part of MMA. Two knees from yesterday. Negligible pain, feel fantastic, mobilising well, declining systemic analgesia. Many thanks @jeffgadsden and @amit_pawa @BlockIt_Hot_Pod

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michael kerr

@mick_kerr

6 months

Of all the Plan A blocks, teaching / supervising the interscalene causes me the most anxiety. So many things in the neck don't want to meet a needle. Here's one tip when struggling to get "good" spread.

Pop above C5 to avoid interscalene block nerve damage

Recent studies have encouraged caution with the traditional technique of placing a needle through C5 and C6 roots. Sometimes it can be difficult to get good ...

www.youtube.com

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michael kerr

@mick_kerr

11 months

We often only show our "good blocks". Here's a close call with the femoral nerve and some lessons learnt from it. #uglyblocks

Difficult femoral nerve - avoiding injury and a near miss

Here we have a difficult to visualise femoral nerveWe often rely on the fascial anatomy to help orientate ourselvesThis, and some confirmation bias, could ha...

www.youtube.com

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michael kerr

@mick_kerr

2 years

Serratus plane block and catheter in anticoagulated rib fractures. Another attempt at amateur video shenanigans... @L_D_White

Serratus anterior single shot and catheter for rib fractures

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www.youtube.com

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michael kerr

@mick_kerr

7 months

Thoughts on this failed axillary brachial plexus block? Hand washout. Had a small patch of seemingly in-tact sensation after 25 minutes. I suspect the answer is more time, though would love to hear other thoughts? @amit_pawa @jeffgadsden @L_D_White

Failed Axillary Block

This was a reminder to always have an alternative plan for a case under regional alone.We performed what we thought was a reasonable axillary brachial plexus...

www.youtube.com

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michael kerr

@mick_kerr

1 year

@BlockIt_Hot_Pod question for the pod. Do you ever think it's reasonable to go past the middle scalene epimesium? I do, but with many caveats / qualifiers / depends whose holding needle ++ caution advised. Too much for a tweet. #Bewwwww

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michael kerr

@mick_kerr

2 months

@Bilal11246014 Everything about this is bad. Then they say it's a TBI intubation... Wow.

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michael kerr

@mick_kerr

1 year

Difficult femoral today. Unfortunate lady with an avulsed? fragment of GT post DHS. Pain + adipose + post op + other excuses. Wanted to do something fancy like an injection under quad femoris to block trochanteric nerve and spare rest of femoral (DOI 10.1002/ca.22035). 1/2

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michael kerr

@mick_kerr

4 years

@KiJinnChin Thanks for your videos on USS assisted paraspinal approach to epidurals. Tried it out on a large patient today, absolutely amazing.

Ultrasound Imaging for Thoracic Epidural Insertion

Ultrasound imaging of the thoracic spine to guide epidural insertion. An extended video that includes a discussion of confirming epidural location, advancing...

www.youtube.com

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michael kerr

@mick_kerr

1 year

@DrNavSidhu Jeff's video is phenomenal. I remember needing a good sit down to get my head around the anatomy of articular innervation and variation. @DrPhilipPeng articles and images helped a lot (thank you). Link to the video here

Nerve Blocks for Total Knee Arthroplasty: Using Targeted Blocks to...

In this video, we look at nerve blocks for total knee arthroplasty, with a focus on anatomic rationale for what we choose. We cover in detail the adductor ca...

www.youtube.com

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michael kerr

@mick_kerr

2 years

One of the most satisfying things I've done this week. I *really* like ropivacaine.

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michael kerr

@mick_kerr

1 year

In the PVB vs ESP debate, is the answer "both"? Had a patient that I really struggled to place a PVB catheter in the other day. Parasag, oblique, transverse, OOP, LOR, for the life of me I couldn't thread. ESP to the rescue (usually the other way round!)

Errector spinae block and catheter

This is an example of an erector spinae plane block and catheter placed after a failed attempt at a paravertebral.

www.youtube.com

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michael kerr

@mick_kerr

4 months

@nmccubs @amit_pawa @BlockIt_Hot_Pod @jeffgadsden The wonderful Dr Lora Penchova from NZ made an excellent literature review / recommended initial infusion document. She also presented this topic at last year's @ASA_Australia conference. She's not on twitter, but gave permission to share. link in reply

Lora ASA talk

Dr Lora Penchova discusses some tips for regional catheter infusions at the 2023 ASA conference.Please see the document in full here:https://asapublicaccess....

www.youtube.com

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michael kerr

@mick_kerr

2 years

@Hermsnz @dannyjnwong Nope, that'd be public. Likely somewhere like Rockhampton where the town is a bit crummy.

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michael kerr

@mick_kerr

1 month

@narcis_anaes Seems to me this is nothing more than an intentional bottleneck for service provision and workforce planning at the expense of colleagues welfare.

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michael kerr

@mick_kerr

1 year

Pretty excited to hear this episode! @L_D_White

How I Do It: External Oblique lntercostal Plane Block - ASRA News

ASRA News is the official newsletter of the American Society of Regional Anesthesia and Pain Medicine (ASRA). Published quarterly online (www.asra.com/asra-news) in February, May, August, and...

pca.st

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michael kerr

@mick_kerr

1 year

List with our new fellow today. Hip and two knees. 3x uss assisted spinals, 1x Peng + lcnt, 2x fem triangle, geniculars. Hip had significant pain in spite of MMA. Some patient factors. There is no "one way" to do anything in regional? @BlockIt_Hot_Pod

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michael kerr

@mick_kerr

8 months

@HalstedMD As a consultant, I'd fail the USMLE without significant dedicated study. Used a bunch of USMLE material for the anzca primary, and I've forgotten horrible amounts of it. These exams teach humility. The more you know, the less you know.

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michael kerr

@mick_kerr

4 months

Cracking talk from Toby Ashken. @RegionalAnaesUK complex topic, summarised concisely. Highlights recent esra guidelines.

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michael kerr

@mick_kerr

3 years

@Dallas_Holladay Calling ED and not anaesthesia for an airway?!? Or was it call whoever's in (which is always ED)? How disappointing that a consultant would let harm come to a patient and colleagues by not helping. Far from beneficence and nonmaleficence. Good on you!

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michael kerr

@mick_kerr

3 years

@AirwayMxAcademy @EM_RESUS @jducanto @NaveenEipe Lots of options. The only thing I feel strongly about is not continuing the case under an lma. If can't intubate, I don't feel excusable to get into an elective SX, lose the airway, and then be up the creek. I'd lift the epi, sneak a bougie behind, or lma Aintree + fibre.

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michael kerr

@mick_kerr

2 years

Phenomenal teaching on a difficult topic. Seeing ultrasound images combined with anatomy is priceless for learning.

Dr Amit Pawa💉🎙️

@amit_pawa

2 years

Got around to recording this talk (initially delivered at #CCFRA ) in 2019 thanks to @SreeHPraveenKO1 & @KalagaraHari Recorded in one (and a bit!) takes, so please excuse any gaffs! #RegionalAnaesthesia #BrachialPlexus

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michael kerr

@mick_kerr

1 year

Blocks by one of our basic anaesthetic trainees. Hoping to provide a bit more regular video feedback to reinforce their learning, scanning, and key decision points in blocks.

Femoral nerve and lateral cutaneous nerve of the thigh (LCNT) block...

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www.youtube.com

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michael kerr

@mick_kerr

1 year

@docmorne @jeffgadsden @chloroprocaine @ASRA_Society @ESRA_Society @LasraAnestesia @AoraIndia @ASALifeline @ASA_Australia @amit_pawa @EMARIANOMD @KalagaraHari @KartikBSonawane @HoltzMaggie @James_Kim_MD @garyschwartzmd @pritanand @colinjmccartney @MoosaFarhaan @Steve_Coppens @claralexlobo @fuzzymittens @CarpenterAdam9 @L_D_White @NarouzeMD @ashwani_doc @dr_tgro @rosie_hogg @LloydTurbitt @Nadia_Hdz_MD @rljohnsonmd @MKwesiKwofie @Jerryblocksthat @jon_bailey_anes @ajrmacfarlane @VeenaGraffMD @nelkassabany @Ropivacaine @ChrisPrabhakar @DrJeniMD @Jennythatcanbl1 @BridgetPulos @lipidguy Love this bit - "Although the patient has the right to refuse any form of treatment, such as the analgesic technique offered or the surgical procedure proposed, neither the surgeon nor the anaesthetist has the right to veto a treatment recommended by the other."

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michael kerr

@mick_kerr

2 years

@jeffgadsden @ASRA_Society @ESRA_Society @LasraAnestesia @AoraIndia @ASA_Australia @amit_pawa @EMARIANOMD @KalagaraHari @ajrmacfarlane @claralexlobo @HoltzMaggie @dr_rajgupta @dr_tgro @rosie_hogg @Nadia_Hdz_MD @Steve_Coppens @PeterMerjavy @James_Kim_MD @VeenaGraffMD @MKwesiKwofie @SreeHPraveenKO1 @CA_PizzaHead @mariapsebastian @galusweegie @DrRobbieErskine @EHigginsMD @Jerryblocksthat @hjas18anes @beckimarshRA @Lucyhos @Duke_Anesthesia @drmugdha94 @the_gasboy @LeroyZimmer @KartikBSonawane @garrettsbarry @ram03kul @jimothysocks @svanhooreweghe Oh no way! Just seen this! How awesome.

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michael kerr

@mick_kerr

2 months

@SJCowell @GasDocYates Was the trauma before, or after the intubation?

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michael kerr

@mick_kerr

1 year

Regional can be pretty rewarding. Pt 1 - severe heart & lung disease avoids a GA with femoral, LCNT, and proximal sciatic blocks. Pt 2 - VT storm and a stellate ganglion catheter with fingers and toes crossed

Quick blocks - proximal sciatic and stellate ganglion catheter

The first block is a trans-gluteal sciatic block in a particularly frail patient.The second is a stellate ganglion catheter placed for refractory VT storm00:...

www.youtube.com

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michael kerr

@mick_kerr

3 years

@edabny62 @TradeTexasBig @fuzzymittens ACLS does not teach how to intubate, it teaches concepts so people can assist if an appropriately skilled and credentialed physician is going to intubate. A layrngoscope is a murder weapon in the wrong hands.

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michael kerr

@mick_kerr

4 months

@ajrmacfarlane @rjharrison79 @OAAinfo @labourpainsOAA @noolslucas @SusannaStanford @ASRA_Society @ESRA_Society @Ropivacaine @NarouzeMD @KalagaraHari @ThomasVolk16 @mokaeleni @mathers_best @numboblivion @ESAIC_org @claralexlobo @docmorne @EMARIANOMD @LloydTurbitt @elboghdadly Good article to compliment it.

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade:...

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - The risk of bleeding complications during regional anesthesia procedures is a significant patient safety consideration....

link.springer.com

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michael kerr

@mick_kerr

6 months

@armyemdoc @JurnBon Previous ED doc turn anaesthetic consultant, I also wouldn't encourage this as SOP. Certainly can see a time for it, but that would be after demonstrating the need. Need may arise from patient/anatomy or environment difficulty or operator skillset.

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michael kerr

@mick_kerr

1 month

@MJTB1987 @VirtueOfNothing @drsas27 I'm fascinated by the UK obsession with the "MDT". The decision as to where to induce anaesthesia should be by the anaesthetist. No one else has the clinical responsibility or liability.

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michael kerr

@mick_kerr

3 years

@EMARIANOMD @ASALifeline @ASAGrassroots @RUBraveEnough @DrMStiegler @Ron_George @ruthi_landau @SapnaKmd @nelkassabany @AmyPearsonMD @CSAHQ Only in America. Absolutely insane. I'm so sorry your medical care is bastardised by profit and inadequate"providers".

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michael kerr

@mick_kerr

2 years

@EMARIANOMD @EngySaid_MD @UCSDAnesthesia @CSAHQ @ASRA_Society @ESRA_Society @RegionalAnaesUK @KiJinnChin @KalagaraHari @Steve_Coppens @claralexlobo @ajrmacfarlane @RodneyGabrielMD It's coke and diet coke. PVB if and when you can, ESP or serratus if you can't or contraindication.

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michael kerr

@mick_kerr

1 year

Great article about the potential toxic doses of ropivacaine after PECSII (IPPS) blocks. Potentially relevant for those performing serratus anterior plane blocks for rib fractures. Great recommendations as well. 1 - monitor for longer (90mins) 1/2

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michael kerr

@mick_kerr

2 years

@amit_pawa @DrRobbieErskine @KiJinnChin It's quite wonderful. Helped a friend the other day in a 90yo infected knee. Big retro goitre pushing on naughty things, prev fusion+decomp. Failed spinal x4 epi x1. Uss --> 1st attempt successful. @KiJinnChin YouTube teaching many across the world + making a difference.

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michael kerr

@mick_kerr

3 years

@martinpepper @RayneKThomanRN @TheRoctor_MD @AmerMedicalAssn Anaesthetists are doctors mate, as are radiologists. They're subspecialties.

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michael kerr

@mick_kerr

4 years

@jeffgadsden @ASRA_Society @EMARIANOMD @Duke_Anesthesia @amit_pawa @KalagaraHari @SreeHPraveenKO1 @MKwesiKwofie @ChrisPrabhakar @Nadia_Hdz_MD @Steve_Coppens Use them all #nofs . If you can find the sartorius, you can find the LCNT with a bit of practice. Lots of variation in anatomy. Always disappointed at people trying a clearly dodgy saphenous block for RA critical surgery (eg amputation in ASA 7) instead of going for femoral.

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michael kerr

@mick_kerr

2 years

Great regional website, and great video on this.

Greater Occipital Nerve Block

Steps to localize the greater occipital nerve.www.usra.ca

www.youtube.com

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michael kerr

@mick_kerr

1 month

@RainShouting I can see this advantage, thank you. We have extended training years in ANZCA, to provide multiple attempts at the exams. You can also apply to take a pause in training, without jeopardizing your training position. Cheers.

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michael kerr

@mick_kerr

2 months

Apparently bungs don't exist either... Yikes.

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michael kerr

@mick_kerr

2 years

@BallouxFrancois @AndyBassett9 I think you've misinterpreted

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michael kerr

@mick_kerr

8 months

@jeffgadsden @ASRA_Society @amit_pawa @EMARIANOMD @Steve_Coppens @DrRobbieErskine @bobfunn @VeenaGraffMD @claralexlobo @Assoc_Anaes @_anapatriciaper @DrJeniMD @tsmurali @KalagaraHari @ajrmacfarlane @hjas18anes @docmorne @MKwesiKwofie @GongGasGirl @jon_bailey_anes Boggles my mind how dense and tasty you manage to make these teaching videos. Thank you!

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michael kerr

@mick_kerr

2 years

@PeterMerjavy @amit_pawa Not between 24-48 hours, just before 48 hours. I think anyone with rib fractures needing more than paracetamol and NSAID should consider meeting some ropivacaine as early as possible.

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michael kerr

@mick_kerr

1 month

@JoeStegemanMD @BlockIt_Hot_Pod @drevanyates @NagdevArun @GoldyMD @trentshemd Following up on my comment, made a video for you! Cheers.

Stellate ganglion block for post-herpetic neuralgia

Post-herpetic neuralgia can be severe and debilitating.This block was performed in combination with some other blocks of the cervical plexus and cranial nerv...

www.youtube.com

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michael kerr

@mick_kerr

9 months

@HouthoffKavita Additives do not work?!?

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michael kerr

@mick_kerr

1 year

@expertknee @amit_pawa Means a lot when surgeons support regional (and also give constructive feedback and expert advice). Regional is awesome, but deeply satisfying when collaborative.

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michael kerr

@mick_kerr

1 month

First rib # catheter in the UK! And it was an... #ESP catheter. Still getting used to not having ropivacaine, but at least I've found these bad boys...

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michael kerr

@mick_kerr

2 years

@TheUmairArshad @DaktarAlmost Valuable ones. Spread it to others (I'm sure you already do!)

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michael kerr

@mick_kerr

2 years

@aidanpdevlin @RegionalAnaesUK @ajrmacfarlane Probably one of the best resources for regional I've come across. I imagine an enormous effort went into that.

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michael kerr

@mick_kerr

8 months

@KalagaraHari @jon_bailey_anes @jeffgadsden @amit_pawa @GongGasGirl @ASRA_Society @EMARIANOMD @BridgetPulos @fuzzymittens @mswami001 @Duke_Anesthesia @zedunow @dr_rajgupta @ankeetudani @anesthesianews @ajrmacfarlane @rosie_hogg @Nadia_Hdz_MD @anesthesiadocmd @docmorne @MKwesiKwofie @VeenaGraffMD @galusweegie @Jennythatcanbl1 @lipidguy @PeterMerjavy @bobfunn @DrRobbieErskine @James_Kim_MD @dr_tgro @SreeHPraveenKO1 @mjoldman @shanercpower @pritanand @DrEAlbrecht @ashwani_doc @AminaBenyoucef5 @acopand @L_D_White @AoraIndia @CAS_RegAnes @Ropivacaine @garrettsbarry @NarouzeMD @DrRiteshRoy1 @DrDiveshArora @anesthetix @tsmurali @kaohesham @Steve_Coppens Difficult. Multiple peripheral nerves involved. Balance of risk/benefit. Sometimes a controlled GA is the answer, or a single shot spinal, or a lumbar plexus, or multiple peripheral nerves, or ketamine +local by surgeon. No great options, tight sphyncter regardless of choice.

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michael kerr

@mick_kerr

2 months

@DocEug3 Sadly that's all me, so neither artificial nor intelligent!

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michael kerr

@mick_kerr

4 years

@ACEPNow How embarrassing

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michael kerr

@mick_kerr

1 year

@garrettsbarry @BlockIt_Hot_Pod @Ropivacaine @jon_bailey_anes @jeffgadsden @glauncel @anesthesiadocmd @PeterMerjavy @Steve_Coppens @rljohnsonmd @EMARIANOMD @KalagaraHari @ButterflyNetInc Absolutely! Amazing how many veins fistula patients seem to have! Part of prescanning for me is managing my own anxiety, rather than simple efficiency.

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michael kerr

@mick_kerr

1 month

@MadanNarayanan @KiJinnChin that anatomy looks... hostile. way i figure it, anything is better than nothing, and thanks for trying!

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michael kerr

@mick_kerr

1 year

@AmitGanguly87 @LiangRhea Is this a junior plastics reg or pho crapping on ED? Sounds like they need guidance.

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michael kerr

@mick_kerr

11 months

@AminaBenyoucef5 Absolutely. So much variation in the anatomy. Starting to use PNS much more often as an extra warning (set to 0.3 or so) rather than to plan needle target. If I get twitches where I didn't expect them, stop and reassess. Cheers.

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michael kerr

@mick_kerr

3 months

@dannyjnwong @beckimarshRA @DrRobbieErskine @HouthoffKavita @bobfunn @rosie_hogg @neumanmd @EMARIANOMD I'm a regional zealot. Reckon I GA 2/3rds of my hips. When it's clinically reasonable to do it under spinal with no / minimal sedation it's Champaign. So many patient and surg factors why GA is also a reasonable choice.

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michael kerr

@mick_kerr

4 months

@ajrmacfarlane @DrRobbieErskine @davejohnston24 @rakesh6282 @RAPMOnline "this is how we might be able to reduce that risk... These are the benefits, and this can happen at similar rates with the surgery under a GA, without those benefits." Ultimately a shared decision, though I think we need to advocate when RA needed, and apply the brakes when not.

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michael kerr

@mick_kerr

2 years

@docmorne @amit_pawa @DrKyleKirkham @DrEAlbrecht @jeffgadsden @MKwesiKwofie Great article. Link here for those interested. . His book is excellent.

High-definition ultrasound imaging defines the paraneural sheath and fascial compartments surroun...

Background and objectives The paraneural sheath is a multilayered network of collagen fibers that surround the brachial plexus. Currently, there are no sonographic data on the paraneural sheath of...

rapm.bmj.com

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michael kerr

@mick_kerr

2 years

@Steve_Coppens @RAPMOnline @JensBorglum @ASRA_Society @ESchwenkMD @dr_rajgupta Reckon "negative" studies are incredibly important, otherwise we end up in an echo chamber, potentially doing things with little to no benefit. Thanks for the hard work!

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michael kerr

@mick_kerr

2 years

@Nadia_Hdz_MD @mac_eden @DrBruceWMYoung1 @Roques_V @_Lirycs_ @fredericleSache @amit_pawa @DrPhilipPeng @DrEAlbrecht @BouarroudjN @baby_blocks @poximuz @DrBluesNYC Agree with @Nadia_Hdz_MD when doing this under peripheral, it's all or none, once those drapes are on you'll regret not blocking something you thought about!

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michael kerr

@mick_kerr

3 years

@DrAlaMahamid @dr_rajgupta @EMARIANOMD @PeterMerjavy @amit_pawa @DrRobbieErskine @Steve_Coppens @shaskinsMD @docmorne @ajrmacfarlane @NarouzeMD @nelkassabany @claralexlobo @canestezi Hadzic's is the obvious answer, 3rd edition out this year? Atlas of Sonoanatomy for Regional Anesthesia and Pain Medicine by Karmakar is good. Always start with proper anatomy before Sono. Can't understand a block, choices, failures, etc without it.

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michael kerr

@mick_kerr

2 years

@AminaBenyoucef5 Such an amazing article. If I'm right, this was with the special edition that included a bunch of phenomenal articles. Some very smart people out there.

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michael kerr

@mick_kerr

4 years

@DLandTheBeard @christinalcee @Eastburbssoc @marklevinshow What on earth do you mean? Covid just isn't an issue in my state, it's like it doesn't exist. We're back to full elective capacity in our hospitals, business is open, people aren't dieing. I'm sorry to see such horrible effects in America. It could have been so different.

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michael kerr

@mick_kerr

3 years

@KalagaraHari @ESRA_Society @ASRA_Society @RegionalAnaesUK @NarouzeMD @EMARIANOMD @amit_pawa @jeffgadsden @claralexlobo @Ropivacaine @mokaeleni @drchadb @dr_rajgupta @nelkassabany @mail2vincechan @JanBoublikMDPhD @KukrejaPromil @elboghdadly @SLKoppMD @rljohnsonmd @PeterMerjavy @Steve_Coppens @LloydTurbitt Looks like I'm going to have to do a dive into their references and see how many excluded obese catastrophasing chronic pain patients, as I fear there's going to be a misuse of recommendations to exclude RA in high risk patients. First step in PICO etc.

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michael kerr

@mick_kerr

2 years

@ajrmacfarlane @EMARIANOMD @Duke_Anesthesia @jeffgadsden @KiJinnChin @amit_pawa @LloydTurbitt @rosie_hogg @LouiseMoran75 @claralexlobo @Assoc_Anaes All three have absolutely changed my clinical practice.

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michael kerr

@mick_kerr

7 months

@Steve_Coppens @athmathottungal @SCasaer @ESRA_Society @BelgianBara @RegionalAnaesUK @ASRA_Society @JournalofClinAn "Regional anesthesia is by far the most effective and important component of multimodal analgesia at our disposal". Agree +++. Multimodal sometimes is just another name for polypharmacy, except for local anaesthetic placed in an appropriate place.

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michael kerr

@mick_kerr

1 year

@IM_Crit_ @precordialthump Makes total sense to me. They're saying even if you fail at your attempt, you'll have gotten some info for second attempt - eg if the oropharynx is crowded, presence of blood, how difficult it looks to pass tube beyond teeth etc. You have more information than before.

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michael kerr

@mick_kerr

9 months

@dramrsharaf @PeterMerjavy @ESRA_Society Conference sounds absolutely amazing. So many phenomenal speakers.

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michael kerr

@mick_kerr

3 years

@claralexlobo @ESRA_Society @alaindelbos @mokaeleni @docmorne @Nadia_Hdz_MD @rosie_hogg @BBreebaart @ajrmacfarlane @athmathottungal @ThomasVolk16 @Steve_Coppens @KalagaraHari @nelkassabany @JoanaMMagalhae @RebeloHumberto @Ronald_Slv_ Relative safety of spinal catheter titrated neuraxial vs GA in critical aortic stenosis would be interesting. Would be great to hear people's practical experience

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michael kerr

@mick_kerr

3 years

@DrAlaMahamid @dr_rajgupta @EMARIANOMD @PeterMerjavy @amit_pawa @DrRobbieErskine @Steve_Coppens @shaskinsMD @docmorne @ajrmacfarlane @NarouzeMD @nelkassabany @claralexlobo @canestezi Should also mention the ANSO (Anaesthesia Sonoanatomy) app by an Australian anaesthetist for pocket reference.

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michael kerr

@mick_kerr

1 year

Femoral nerve blocks have some of the most "bang for buck". Tip to past me #1 - the nerve is often quite lateral, can be difficult to differentiate, and can be very flat.

Femoral nerve block - Commenting on technique

A quick video discussing the performance of a femoral nerve block. This was for a 90 year old patient for a femoral fracture.

www.youtube.com

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michael kerr

@mick_kerr

1 year

@amit_pawa @jeffgadsden @BlockIt_Hot_Pod Jeff was the one that inspired me and gave me some tips! As generous with his tips as he is with teaching. I don't think I'll ever get to his level, but I'm enjoying learning a new skill.

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michael kerr

@mick_kerr

2 years

@jeffgadsden @L_D_White Awww cheers! Had to get a GadsdenZipper(TM) moment. :)

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michael kerr

@mick_kerr

1 year

@L_D_White @amit_pawa @BlockIt_Hot_Pod @BJAJournals @ESRA_Society @RegionalAnaesUK @jeffgadsden @KartikBSonawane @anesthesiadocmd wouldn't have done a PVB can do *something*. mechanistically inferior in some cases (go a bit deeper), yet for the same reason is potentially safer (less bleedy into precious bits). don't think there's any "ultimate plan A", but it's catchy. I've added the article by Moustafa2/3

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michael kerr

@mick_kerr

1 year

@garrettsbarry @Steve_Coppens @jon_bailey_anes @BlockIt_Hot_Pod @Ropivacaine @jeffgadsden @glauncel @anesthesiadocmd @PeterMerjavy @rljohnsonmd @EMARIANOMD @KalagaraHari @ButterflyNetInc I'm also using it as a teaching tool, prior to chlorhex prep. And often recording scans for later teaching (and learning)

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michael kerr

@mick_kerr

2 months

@KiJinnChin @ASRA_Society @NagdevArun Very much agree. So much acute pain and suffering could be relieved. Much more efficient use of resources. Eg shoulder relocation - 10ml lidocaine Vs procedural sedation in resus bay. Blocks for rib #. Many questions about training, governance, follow-up, expertise etc.

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michael kerr

@mick_kerr

2 years

@hjas18anes @anesthesiadocmd @ASRA_Society @KalagaraHari @Nadia_Hdz_MD @HoltzMaggie @AminaBenyoucef5 @PeterMerjavy @claralexlobo @jeffgadsden @AmandaKumarMD @nelkassabany @NarouzeMD @Jerryblocksthat @amit_pawa @DrJeniMD @SylviaHWilson @dr_tgro @DrTuhinM No probs! All the names can get confusing, more reasons for the attempts to standardise nomenclature I guess.

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michael kerr

@mick_kerr

1 month

@GreensladeGL Reckon they're a great thing to have - exactly as you say, blocks, checks, lines etc, helps with efficiency for the next case. would rather have one than not. Just not GA in them.

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michael kerr

@mick_kerr

1 year

@dr_rajgupta @jeffgadsden @VeenaGraffMD @Steve_Coppens @EMARIANOMD @theRodrigoDaly @garrettsbarry @jon_bailey_anes @BlockIt_Hot_Pod @Ropivacaine @glauncel @anesthesiadocmd @PeterMerjavy @rljohnsonmd @KalagaraHari @ButterflyNetInc @amit_pawa @dr_tgro @HoltzMaggie Preach it. We wheels in 24mins "late" surgeon bagging out anaes team whilst scrubbing. Explained to them that 30 mins for difficult iv access(X3), equipment failure, spinal, blocks, and GA (slow operator) isn't a reasonable source of their focus. Next knee took 3hrs surg time. 🙄

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michael kerr

@mick_kerr

7 months

this article sprang to mind, though we knocked off median very proximally, targeted the medial cutaneous nerve of the forearm and LCNF (via MCN). not enough local to the superficial aspect of median nerve?

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michael kerr

@mick_kerr

4 years

@amit_pawa Shouldn't it be pvb+pecs1? Doesn't pvb alone forget the lateral and medial pectoral nerves?

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michael kerr

@mick_kerr

2 months

@drevanyates @BlockIt_Hot_Pod @amit_pawa @jeffgadsden @NagdevArun Motor sparring pretty much always = less analgesia and utility - less useful for joint reduction / severe pain / wound washout & repair etc. Would put it down on the list of ideal ED block properties in favour of safety, efficacy, versatility... All the qualities of plan A blocks

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michael kerr

@mick_kerr

4 years

@kyliebaker888 @amit_pawa @usabcd_org @rosie_hogg @Wilkinsonjonny @PARADicmSHIFT @elboghdadly @GSTT_ICU @GSTTanaesthesia And

Lung Ultrasound for COVID-19 by Dr. Kylie Baker

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www.youtube.com

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