This week’s VOTW is brought to you by the US Team Drs. Jennie Xu and Laura Gonzalez and ED team Drs. Jennifer Wolin and Daniel Evans!
HPI: 45 year old male with no PMH presenting for left shoulder pain after falling off his scooter today. He was found to have an anterior shoulder dislocation and luckily the US team was available for an interscalene nerve block to help with pain control and an easier shoulder reduction!
Supplies you’ll need
Chlorhexidine
US probe cover
Echogenic needle
Sterile flush
10 mL of 1-2% lidocaine with or without epi (short acting anesthetic because it’s just for the shoulder reduction and has the potential to cause diaphragm paralysis- remember C3-5 innervates the diaphragm).
Place your linear probe at the medial/anterior neck at the level of the cricoid cartilage. Visualize the “stoplight” between the anterior and middle scalene muscles. The stoplight represents C5-7 in the brachial plexus.
Advance your echogenic needle through the prevertebral fascia and continue to bath the nerves (C5-7) with lidocaine. Use your saline flush to make sure you are in the right fascial plane prior to injecting your lidocaine.
Case conclusion: The ED team easily and quickly were able to reduce the patient’s shoulder dislocation!
Happy Scanning!
The US Team
References