EM Vivas · Regional nerve blocks
Regional nerve blocks — fascia iliaca and LAST viva
Clinical viva on ED regional blocks, LA dose ceilings, and ASRA lipid protocol.
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Target exams
Interpretation
Reveal interpretationShowHide
Fascia iliaca. Landmark: ASIS to pubic tubercle, junction of lateral third and medial two-thirds, 1–2 cm caudal; two pops (fascia lata then iliaca); 20–30 mL long-acting agent. US: deposit deep to fascia iliaca over iliacus, watch hypoechoic spread.[1]
Doses aloud. Lidocaine 3 mg/kg plain (7 with adrenaline); bupivacaine 2 mg/kg; ropivacaine 3 mg/kg. Prefer ropivacaine in frail large-volume blocks. Aspirate every aliquot.[1]
LAST. Prodrome (metallic taste, tinnitus, agitation) → seizure → wide-complex cardiovascular collapse. Lipid emulsion 20% 1.5 mL/kg bolus then 0.25 mL/kg/min. Airway, benzo for seizure; avoid lidocaine for arrhythmia; prolonged CPR may be needed.[2]
Digital block. No adrenaline on the exam answer. Compartment syndrome remains possible after FICB — tense swollen leg is not "block still working".[1]
References2ShowHide
- [1]Guay J, Parker MJ, Griffiths R, et al. Peripheral Nerve Blocks for Hip Fractures: A Cochrane Review. Anesthesia and Analgesia, 2018.PMID 28991122
- [2]Neal JM, Barrington MJ, et al. The Third ASRA Practice Advisory on Local Anesthetic Systemic Toxicity. Regional Anesthesia and Pain Medicine, 2018.PMID 29356773