Paper Chase 1: Hematoma Blocks

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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Lisa Chavez, RN, and Kathy Garvin, RN
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Aaron G. -

I still use hematoma blocks (with no sedation) about 50% of the time in pediatric distal forearm fracture reduction. It works great, provided you pick your patients (and parents) properly. You're not doing this in the screaming 3 year old (or the screaming 16 year old with the emotional maturity of a 3 year old) who can't get over the fact that they have pain, let alone the fact that now someone's going to be poking the source of their pain with a big scary needle. And if you run into problems with patient compliance then you can always just say you tried and switch over to a sedation approach.

http://www.ncbi.nlm.nih.gov/pubmed/25306504

I also can't remember the last time I sedated a geriatric patient with a distal forearm fracture that needed reducing. They usually tolerate reduction with a hematoma block very well.

Nathan M. -

Hematoma blocks are not the easiest to perform. I do them regularly and it's often difficult to get into the fracture site (particularly those less displaced). I would be interested to see if ultrasound is helpful.

Jaron C. -

I am a huge fan of using hematoma blocks, and ultrasound can definitely be helpful ... another trick is to use a C-arm if it is available to you -- bonus when setting the bones and seeing them align in real time directly in front of you.

Michael P., M.D. -

Hematoma blocks are great, especially in the elderly colles who you don't want to sedate. The key is to 1) use enough volume of local and 2) leave them alone long enough to let the block take effect- forget them for a bit/ go see another patient or 2 and then come back to do the reduction. Have had several occasions of pulling my best on an arm and the little old man/lady commenting on how hard I am working to fix the fracture. The block tolerated and often works very well. Can always fall back to sedation if it happens not to work.

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