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Uh, okay. Years, guys, um, like from here, Anything in the moments here. Um, so today, I'm going to try to avoid to the fascia. Lack of lock in the department is well, so I'm sure many of you know how to do yet, but it's just a brief update on what it is. Um Hum, can you hear me? Okay. Yeah, we can hear you. Yeah. I just can't get this to go on eggs. Uh huh. You said you go to the end of the presentation, then are ready to increase knowledge and awareness of the block within the department. I'll try to better, but then I'll wait for me. Um, and the indications and contraindications to you and myself and I got bills have been looking into getting a thermal nerve block drawer within the department to try and make it easier to complete the blocks on. Then also looking at an idea for a sticker to put in the notes so that everybody has to see him sort of information and documented for each time a NOX block is completed. So why do we use, um uh, well, the minute reason we would use, um, is for, uh, neck of femur fracture. Their significant calls Apia On often, patients come in already having have IV morphine or quite serious pain relief, so they can either be completed using our land marks or ultrasound guided approach. And with the nerve block, we came to block the family of the lateral cutaneous, never the thigh, and there's also some blocking off the tree it or nervous well compared to the family nerve block. The fat block itself is more lateral and the needle and is last likely to hit the family of itself under just the risks. Both injury to the nerve on the studies have shown that there's no real difference between a family of four or five blocks in terms of efficacy. So then anatomy on how we decide where the block is completed. And what you do is you to keep your anterior superior really explain on. Then you look for the pubic. Typical is, well, this peace between these two areas and then divided into thirds on the joint between the lateral third and the 2nd 3rd, 1 centimeter below. That is where you would want to, um, inject your local anesthetic. The first picture here. Just choose the area that you want to actually get your block in. Two. So it's a space between your low source muscle on dure fascia. Fascial yaka. So when you're pushing the needle three, you'll feel your first part of the fascial after second of the Fascial lacquer and then, But if that is really a source muscles, so that's the speediest between that you want to try and get the block into. So our indications and the ones that are documented on the um Arkan website are really honesty's every patient to the neck of humor fracture on. Then they also mentioned about it honestly easier for Children and plaster. But this would obviously be forward discussion of the senior or consultant be doing the so army and the and then is really, really helped apologies there for next few months fractures with our overall, um, to be reduced in their mind of opioid a nonsteroidal requirements. Obviously, opioids have quite a few side effects of trend of weight on nonsteroidals. Well, especially in an elderly population, you're slightly the half. They're fractured my office. So are contra indications. And as with most all procedures, patient refuses with the patient. Let's get past the Endocet one of block. That is a complication. Every patient's have previous stem will bypass surgery. A block shouldn't be completed or if they have any signs of inflammation or infection over the injection site. But evidently fight. You shouldn't be going ahead with the block. You also want to check their possibility history to see if there's any allergy. Symbicort Anesthetic on This used to be a contraindications like only relative if the patient is on the coagulation and it's a possible contraindications. But if they're really severely in peeing on, say the writers know or they have been, it's still a possibility to give somebody a block if they're on a coagulation. So there are complications of the nerve block is well, it's important to be aware of if you have your intervascular injection, so you want to make sure you're not. Marks are located correctly. Before procedure proceed are proceeding. You also have the risk of local anesthetic toxicity. You have temporary permit nerve damage, too. If the local anesthetic is injected directly into a nerve, there is a risk off and damage to the nerve itself. You also have the risk of ingesting infection. A lot of these blocks would be up to a half. Then maybe we don't have the desired effects in terms of good be in early or perfect being relief. But and that's always a risk with with any nerve block. And you may also have some preoperative, and on this or weakness or an allergy to the preparation is being used in terms of then that's a lot of static we'd like to use within the department. The one that we have we would usually use would be because you can really perfect. And the block itself is what's known as a volume dependent blocks. You want to get a much volume and around the nerves, it's possible to achieve your goal. Blocking the nerves. Um, you also want to be aware that with little bit cookie and or picky and the maximum see if the nurses to mother grams per kilo. So when you're looking at the Levaquin, the one we have in the department is not 10.25% so one little of this would continue to 10.5 mg on then 40 miles would continue hungry, so you want to try and get the wheat of a patient as well, Which is important if a patient is below 50 kg, Arkan guidelines would still you should consider 30 miles. But this is also may be too much for some very small patients. You want to have a look back, Julie it if they're over 50 kg to see if that will be between 30 and 40 as appropriate. And some people also like to add in a bit low 1% lidocaine. But obviously working that all is well with the see if this is I'm not going to chat completely through the method. But when we get our nerve book drawer up roaming, we will have this math and print it right on. Put in the drawers well for people to follow. So it must have been the weight. You want to get consent to confirm the patient on the side that you want to look, you want to have good monitoring on high and time for before or after. I have the patient at position correcting. Do you want to have my lesson flat and you want to drop your material on then, as we discussed when the correct area for your book. You also. It's very important, given that this could be quite a dirty area. But sure, the skin skin is completely king. Do with your hand your prep you want to, and when you're putting the needle and you want to know what, maybe degrees the skin, and you want to feel the two distinct pops to chat about one through the fashion latter on the Fascial Yaka. You want to ask for it before you start to inject on. Then after you start to inject, you should be expecting roughly every five mils to make sure that you haven't changed position and you haven't gone into your vessel. At the end of the procedure, you withdraw the navel and put on pressure. It's always quite good as well did tell the band doin and about went to keep their the anesthetic in the area. We'd like to stay on. Then you have to do regular OB says well, every five minutes for 15 minutes, then at 30 minutes on them for already there after, uh, another good point is to always documents, and then it's, um, were you on the block? What time it was asked on that at least things were completed appropriately. So pet full of sand that are quite common. A common one would be that you haven't felt both pops. When you been putting the needle in suggested action from fr can. What are our cameras? To withdraw the needle, check your marks again on you may need to change your position. If you hit building of thumb with advancing, you probably too deep or you're maybe not getting the correct angle. Blood. You probably hit a vessel, so you need to take it out. And there there might be a little bit of pee, and but there shouldn't be severe pee. And so if you are getting the patient complaining of severe peeing, you're probably not in the right areas. Well, on the novel, See? Know when you're saying is of local anesthetic toxicity. So, Dominus tennis, dizziness or seizures. If the patient has no pain relief, and you can always have a look what you've given them in terms of how many meals on whether you can give us like, top up or whether you're gonna need different little dizzy about wheat instead. So what? Myself and I have been looking at is coming out with a nerve block drawer. We're hoping to get sterile pox. We have nurse than the liver needles. I am 20 mil syringes skin. I'm going to get the Are cam guidelines put in his well, just about so in one area makes it easier to complete the blocks. It also been hoping to get a sticker to put into the notes as well, or as part of an overall north packet. It's going to be in a donut, a different separate order within the department. And what we'd like to see in the lips really is a block site indication. The time and it it was inserted by on what local anesthetic was used, what percent it was, how much was used. And we saw the documents. What if consent was getting too from the patient? So that's my talk. There's no references. If anybody has any questions, thanks very much. That's great. Yeah. Thank you. It's nice. Quick care around three off the F. I block so and just drive home that, you know, this is a standard of care now, you know. And if we haven't had a fever in the department. This should be having in there five block everything that's so important that we get these patient's comfortable and again these recurrent things come up through. The talk today is that we want these patients to be getting analgesia on just because of demented. And what you're telling easier doesn't mean that shouldn't get that. So please, please, please have a dog. You know, especially the older population that really created enough. I bloat because you can't avoid on the opiate medication or you can't least we're just so much with the medication you need. So and if you do get on a patient like a femur and you're not sure how you do, you know, if I have a lot of green haven't done one before, where they come and get someone who dogs. No, I didn't. I will happily teach you and show you a video. And the question is, um call them just says what would commonly and really encourage complications of block be, I suppose. Obviously, if you're having resistance when you're putting the needle in or trying to inject, you may have gone too far with really a Swiss and other complication to be that the patient has a hard out of quit purely from us. And if they have strange, not on me or if the patient's quite big, you have to make sure the skin would also be taught when you're looking at your landmarks and then when you're proceeding for the later on to make sure that it's in the same sort of possessions. So if someone's able to hold the skin back, if it's a bigger patient, there's no difference between when you've identified you're not marks, and then when you're injecting is well, yeah, I think I am. Can top that's would be to make sure you've got enough helpers with you, especially that got in April. You get someone to call the April at the way for you so you can see what you're doing. And still, every probably I would sort of give to people is after you put the the bend together. Have during this lightly is a little bit like, um, a spinal ones that if you get a head dying, you're getting more proximal block so and less energy and jack term your your block. Get pressure on dust. Elated where you've injected on, get their feet up in the air low. But that should encourage the captopril small blow. Could be maybe Yeah, great. I think that's coming off the hook a day. It's a well done. Thank you. And thanks for your work on that. Because, I mean, it was not good project. So hopefully we can and keep Belvin or not. Thank you. That's great. Thanks.