MedBugs: SAQ #38

Case: Foot nerve block

You are working in a regional coastal emergency department. A 34-year-old male presents with multiple lacerations to the sole of his right foot from oyster shells after slipping on a rock whilst fishing. He reports no other injuries and has no significant past medical history or allergies to note. Your SRMO wishes to perform a regional nerve block to anaesthetise the plantar aspect of the right foot in order assess and clean the wounds.

1. Complete the table below, listing the (3) nerves involved and how to find their anatomical landmarks for local anaesthetic infiltration. 6 marks

2. What would be the maximum volume of 0.5% Ropivacaine for this patient, assuming a weight of 80kg. Show any relevant calculations. 1 mark

Prior to the local anaesthetic infiltration, you discuss local anaesthetic toxicity and its clinical manifestations with your SRMO.

3. List (6) neurological features of local anaesthetic toxicity. 6 marks

Fifteen minutes later you hear the emergency alarm from the procedure room. On your arrival the SRMO informs you that the patient reported feeling strange and then rapidly deteriorated. He is unresponsive with a slow thready pulse on palpation.

4. After immediate cessation of local anaesthetic administration, state (5) key priorities of resuscitation in severe local anaesthetic toxicity. 5 marks

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Case: Foot nerve block

1. Complete the table below, listing the (3) nerves involved and how to find their anatomical landmarks for local anaesthetic infiltration. 6 marks

2. What would be the maximum volume of 0.5% Ropivacaine for this patient, assuming a weight of 80kg. Show any relevant calculations. 1 mark

3. List (6) neurological features of local anaesthetic toxicity. 6 marks

4. After immediate cessation of local anaesthetic administration, state (5) key priorities of resuscitation in severe local anaesthetic toxicity. 5 marks

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