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Door-to-block time: prioritizing acute pain management for femoral fractures in the ED

Published:March 28, 2014DOI:https://doi.org/10.1016/j.ajem.2014.03.027
      Ultrasound-guided femoral nerve blocks (UGFNBs) are considered the criterion standard for acute pain management in traumatic femoral fractures [
      • Mutty C.E.
      • Jensen E.J.
      • Manka M.A.
      • Anders M.J.
      • Bone L.B.
      Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department.
      ]. Emergency physicians (EP) are ideally positioned to perform the UGFNB in a timely manner but often are forced to delay block placement because of unresolved or ambiguous practice expectations on the part of collaborating orthopedic, anesthesiology, and trauma surgery services [
      • Berben S.A.A.
      • Meijs T.H.J.M.
      • van Grunsven P.M.
      • Schoonhoven L.
      • van Achterberg T.
      Facilitators and barriers in pain management for trauma patients in the chain of emergency care.
      ]. The use of a multidisciplinary consensus protocol to expedite acute interventions in the emergency department (ED) is a well-established strategy with proven success in improving outcomes in sepsis, acute coronary syndromes, and stroke [
      • Dellinger R.P.
      • Levy M.M.
      • Rhodes A.
      • Annane D.
      • Gerlach H.
      • Opal S.M.
      • et al.
      Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.
      ,
      • O’Gara P.T.
      • Kushner F.G.
      • Ascheim D.D.
      • Casey D.E.
      • Chung M.K.
      • de Lemos J.A.
      • et al.
      2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions.
      ,
      • Fonarow G.C.
      • Smith E.E.
      • Saver J.L.
      • Reeves M.J.
      • Hernandez A.F.
      • Peterson E.D.
      • et al.
      Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: stroke initiative.
      ]. Despite the clear benefits, such a protocol has not yet been described for emergency regional anesthesia in acute trauma patients.
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