Recommended resources for PoCUS Guided Nerve Blocks in EM
This page is under maintenance – future updates will include a ‘Plan A‘ list of blocks with associated guides.
EMSJ Resources
Collection of our nerve block guidelines, clinical pearls and rounds
Fascia Iliaca Block
Guideline
Rounds
Serratus Anterior Plane Block
Rounds
Dental Block
OK, this one isn’t PoCUS guided but it’s still very good!
Regional Anesthesia of the Hand
Other Resources
Local Anesthetic Dose
| Anesthetic | Weight Based Dose (Wallace 2015) | Maximum Dose (Rosenberg 2004) | Duration (Tsai 2007) |
| Lidocaine Without Epi: With Epi: | 4.5 mg/kg 7 mg/kg | 300 mg 500 mg | 60-120 mins 90-180 mins |
| Bupivacaine Without Epi: With Epi: | 2.5 mg/kg 3 mg/kg | 175 mg 225 mg | 180-360 mins 300-480 mins |
| Calculating LA doses: |
| 1% = 10 mg/mL |
| 0.5% = 5 mg/mL |
| 0.25% = 2.5 mg/mL |
LAST
Local Anesthetic Systemic Toxicity (LAST) as a complication of inadvertent intravenous or intra arterial anesthetic injection.
- Incidence: 8–30 in 100,000
- Manifestations: typically occur within 20 minutes of injection (although onset can be as late as >1 hr) and are primarily neurologic and cardiovascular in nature. Neurologic effects include perioral numbness, metallic taste, mental status change or anxiety, muscle twitches and visual changes, followed by loss of consciousness and seizure. Cardiovascular effects are hypertension and tachycardia followed by arrhythmias, bradycardia, hypotension and cardiac arrest.
- Treatment: intravenous lipid emulsion therapy (Intralipid 20%) 1.5 mL/kg bolus followed by 0.25 mL/kg/min, Maximum total dose 12 mL/kg. Contact your poison control centre if you suspect LAST.