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Ultrasound-guided forearm nerve blocks for hand blast injuries: case series and multidisciplinary protocol

      Ultrasound-guided nerve blocks are an effective tool for management of traumatic orthopedic injuries in the emergency department (ED) [
      • Johnson B
      • Herring A
      • Shah S
      • Mantuani D
      • Nagdev A
      Door-to-block time: prioritizing acute pain management for femoral fractures in the ED.
      ,
      • Mutty CE
      • Jensen EJ
      • Manka MA
      • Anders MJ
      • Bone LB
      Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department.
      ,
      • Stone MB
      • Price DD
      • Wang R
      Ultrasound-guided supraclavicular block for the treatment of upper extremity fractures, dislocations, and abscesses in the ED.
      ]. Specifically, ultrasound-guided forearm nerve blocks are effective for acute hand injuries [
      • Liebmann O
      • Price D
      • Mills C
      • Gardner R
      • Wang R
      • Wilson S
      • et al.
      Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department.
      ,
      • Frenkel O
      • Liebmann O
      • Fischer JW
      Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department.
      ,
      • Sohoni A
      • Nagdev A
      • Takhar S
      • Stone M
      Forearm ultrasound–guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers.
      ]. Firework blast injuries accounted for 26 000 ED visits from 2006 to 2010, with the hand being the most frequently injured body part [
      • Canner JK
      • Haider AH
      • Selvarajah S
      • Hui X
      • Wang H
      • Efron DT
      • et al.
      US emergency department visits for firework injuries, 2006-2010.
      ,
      • Moore JX
      • McGwin Jr., G
      • Griffin RL
      The epidemiology of firework-related injuries in the United States: 2000-2010.
      ]. Hand blast injuries involve burns, lacerations, complex soft tissue and ligamentous injury, or amputation [
      • Coulet B
      • Lacombe F
      • Daussin PA
      • Chammas M
      Treatment of blast injuries of the hand.
      ,
      • Hanh P
      • Brederlau J
      • Krimmer H
      • Lanz U
      Explosion injuries of the hand: spatial relationship and injury pattern.
      ,
      • Hazani R
      • Buntic RF
      • Brooks D
      Patterns in blast injuries to the hand.
      ]. Analgesia, antibiotics, immobilization, hemorrhage control, and orthopedic consultation are the foundation of ED management [
      • Bumbaširević M
      • Lesic A
      • Mitkovic M
      • Bumbaširević V
      Treatment of blast injuries of the extremity.
      ,
      • Saucedo JM
      • Vedder NB
      Firework-related injuries of the hand.
      ]. Ultrasound-guided forearm nerve blocks are an effective adjuvant to a multimodal ED pain management strategy for these injuries, especially in situations involving delays to operative management (eg, busy holidays, multicasualty incidents, limited surgical staff/facilities).
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