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Sachin Bansal
2/23/2024

We proposed an alternative method of rib counting from caudal to cephalad as continuously facing problem in rib counting in obese female patients. Expert opinion over this method of rib counting in SAP block.

https://journals.lww.com/ijaweb/fulltext/2024/68030/enhancing_ergonomics_in_rib_counting_in.15.aspx

NYSORA Learning System
2/22/2024

Based on the specifics of the case provided, what treatment plan and interventions would you propose to effectively address this patient’s condition?

The Puppeteer CANADA
2/21/2024

We are reaching out to specialists and organizations with experience on IVRA Forearm Bier Block (mini-block) procedures. Whereas NYSORA, invited us to publish on (LMS).

Patients are being exposed to LAST (Local Anesthetic Systemic Toxicity) at an alarming rate that is resulting in Hypertensive Emergency and/or death.

Whereas strokes, WMH (White Matter Hyperintensities) and death is occurring in youth, whereas the causation is LAST. Whereas the misuse of anesthetics, mismanagment of tourniquet (Bier Block) and other factors are the causation of LAST.

The concerning aspect here, is not the presence of accidental or negligence. The concern, is the spread of misinformation from the government of Canada and/or public bodies associated to complaints/reviews, to protect their interests at the expense of the people. Whereas other anesthesiologist’ in Canada are being exposed to dangerous misinformation.

The term “Bier Block” procedure for an arm is sometimes misconstrued. A procedure with the tourniquet applied below the elbow, is called an IVRA forearm Bier Block, also known as a mini-block. This procedure is sometimes confused with the more traditional IVRA Bier Block procedure with the tourniquet applied above the elbow, also known as an IVRA upper-arm Bier Block.

The dosage and volume is determined by the type of Bier Block procedure, the weight of the patient and any pre-existing conditions of the patient.

Whereas it is being stated, the use of 300 mg – 400 mg of lidocaine @ 0.25% (120 ml – 160 ml) injected intravenously for an IVRA Forearm Bier Block (mini-block) is safe and within the standard of practice.

Whereas it is being stated, the use of 300 mg – 400 mg of lidocaine @ 0.25% (120 ml – 160 ml) and marcaine (bupivacaine) with epinephrine injected intravenously for an IVRA Forearm Bier Block (mini-block) is safe and within the standard of practice.

Whereas it is being stated, an injection rate of 60 ml/s into a vein catheter is safe and within the standard of practice (as long as the catheter does not rupture).

Whereas it is being stated, the surgeon does not have to notify the anesthesiologist, he/she is injecting marcaine with epinephrine into a patient during a procedure nor does the anesthesiologist have to retain knowledge of such actions and claims this is safe and within the standard of practice.

Whereas it is being stated, after exsanguination of the forearm and removal of esmarch bandage, if the anesthesiologist forgets to instill the butterfly catheter. The anesthesiologist may request the patient to contract his/her hand/forearm whilst the Bier Block is applied and inflated on the forearm, to identify the dorsal vein and claims this is safe and within the standard of practice.

Whereas it is being stated, after completion of surgery, the tourniquet may be deflated by yanking the cuff lines out. That incremental depressurization (graded tourniquet deflation) is not required and claims this is safe and within standard of practice.

Whereas it is being stated, following Hypertensive Emergency from a LAST event. Conducting a troponin test within 40 minutes of suspected stroke is adequate and refutes the requirment to conduct a troponin test four (4) to six (6) hour post drug-related overdose, is not required.

Whereas it is being stated, following Hypertensive Emergency from a LAST event. It is not required to conduct CT scan and/or MRI of the patient’ brain. In the event a youth with no known diseases or illnesses acquires WMH following Hypertensive Emergency from a LAST event. The WMH’ are due to age related causes, not the drug-related overdose.

There are many negligent factors beyond what has been listed. Statements and medical doctors spreading nefarious claims in Canada. However, this must be addressed to ensure safety of patients in Canada.

We welcome input from specialists and organizations interested on addressing this matter. Please respond VIA public forum post or privately at:

info@thepuppeteer.ca

NYSORA Learning System
2/20/2024

Have you encountered similar cases of post-herpetic neuralgia? If so, what pain management techniques or strategies have you found most effective in providing relief to your patients? Share your experiences and insights below.

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