Serratus Anterior Plane Block

Transcript

• 00:01Welcome to Yale emergency ultrasound
• 00:03nerve block series.
• 00:05Today, we're going to go
• 00:06over serratus anterior plane block.
• 00:08That way, you're ready to
• 00:09block at your next shift.
• 00:11The first step is to
• 00:12go to the cart by
• 00:13the ultrasound station near a
• 00:15sixteen.
• 00:16On the bottom drawer, you
• 00:17will find premade kits to
• 00:19use for nerve blocks.
• 00:22The kits include a sterile
• 00:24probe cover,
• 00:25chloroprep,
• 00:27a saline flush, an echogenic
• 00:29needle,
• 00:30a blunt needle, and a
• 00:31ten cc syringe.
• 00:35Because this is a large
• 00:36volume block, make sure to
• 00:37have the patient on the
• 00:39telemonitor
• 00:39before you start. Local anesthetic
• 00:42systemic toxicity is rare but
• 00:44life threatening.
• 00:45Have the patient's weight updated
• 00:47in the chart and use
• 00:48MD Calc, local anesthetic dosing,
• 00:51to calculate the maximum dose
• 00:53allowed for this plain block.
• 00:55Make sure to review with
• 00:56the pharmacist.
• 00:57For more information on LAST,
• 00:59please review the material in
• 01:01the email sent to you.
• 01:04Now we will use our
• 01:05ultrasound to identify the anatomy.
• 01:10Identify the latissimus dorsi,
• 01:13serratus anterior,
• 01:15the ribs, and the pleura.
• 01:17We have two options for
• 01:18this plain block. We can
• 01:19either inject anesthetic
• 01:21under the latissimus dorsi
• 01:23or under the serratus interior
• 01:25on top of a rib.
• 01:28Now let's review the anatomy
• 01:30using our ultrasound.
• 01:32Our indicator is in the
• 01:33transverse orientation
• 01:35towards the operator.
• 01:37The first layer of muscle
• 01:38we see is the latissimus
• 01:40dorsi. Under it, we see
• 01:42the serratus anterior.
• 01:44The rib is seen with
• 01:45a pleural line below it.
• 01:46The two stars indicate our
• 01:48possible locations for this block.
• 01:51Stay sterile, and the assistant
• 01:53should push the syringe.
• 01:54Visualize the needle at all
• 01:56times. Once your needle is
• 01:57in the correct position, have
• 01:59your assistant push saline slowly.
• 02:01You should be seeing hydrodissection
• 02:03of the fascial plane.
• 02:04Now you can have the
• 02:06assistant switch to anisone.