4 ms·

That’s why we use ultrasound on practically every block we do today.

ProllyInfamous 2y ago
Would you consider investing in becoming an imaging technologist in today's US healthcare market? IIRC, ultrasound is top of that payscale..?
- devilbunny 2y ago
  I honestly don’t know anything about that market. We don’t use sonographers because it’s interventional; I need to be able to control my own view very tightly.
- citboin 2y ago
  Nuclear Medicine Technologists earn more.
meroes 2y ago
Is ultra sound that little monitor they/you look at while the needle thing is in your arm to apply the nerve block? That process a bit unnerving no pun intended. I thought maybe since my arm had been tweaked by being in a full arm cast for a month even with the screen they weren’t going to find it.
- devilbunny 2y ago
  Yes. You can see the needle, see the tissues. Nerves sometimes aren’t visible right where you want to block them, but if you can see them headed in the right direction and then see the structures they are supposed to be (and usually, though not always, are) near, you can make good guesses and get results.
bookofjoe 2y ago
For perspective, when I learned to do nerve blocks (UCLA Department of Anesthesiology, 1977-1980 residency), portable ultrasound for guidance was a pipe dream. For the axillary approach to brachial plexus blocks, we tried to elicit paresthesias from actual needle impaction on nerves and then pulled back a tad and injected a bolus of anesthetic. We did that repeatedly, aiming to deposit anesthetic near each branch of the plexus. Failing that, hitting the brachial artery with the needle and then continuing to advance the needle until no blood could be aspirated, injecting half the intended volume of anesthetic (2% lidocaine with epinephrine 1:1000) behind the vessel, then withdrawing the needle until no blood could be aspirated and then depositing the remainder of the anesthetic on the front side of the artery was the technique of choice. Diff'rent strokes.
- vinay_ys 2y ago
  Surprised to find a bunch of anesthesiologists hanging around here. How come?
  - bookofjoe 2y ago
    HN is my favorite place on the internet. I only wish I'd discovered it before I stumbled on it in 2016.
  - devilbunny 2y ago
    Last time I counted there were three or four of us, but bookofjoe is a prolific reader and poster courtesy of being retired. We have a lot of down time during the day, just in very short increments. Thus the stereotype that we’re all crossword/Sudoku nerds. HN is something you can pick up and put down in a moment. Also, I have always thought of the job as a sort of human engineering, or a big physiology lab. Programmers have REPL; we have vital sign monitors for instant feedback. Thankfully it is difficult to crash a human accidentally. People think doctors bought computers early because they were rich. They could, but it’s worth remembering that if you were a science-and-math kid in the post-WW2 era, medicine and engineering would be the fields you would be pushed toward. That is not as prominent now as tech has started paying better and medicine less, but it’s still not terrible reasoning. I would have to screw up a lot to be unemployable, even if it did take me a lot of school to get to that point. Doctors bought computers because they looked fun. Only one of my partners has an engineering degree (MechE). I majored in chemistry. Two pharmacists, one accountant. Don’t know about the rest.
    - bookofjoe 2y ago
      "I have always thought of the job as a sort of human engineering, or a big physiology lab." I like this. I used to tell med students doing a month-long rotation that the specialty could be described as a combination of applied physiology/applied chemistry/applied anatomy with the great thing being you get to find out if you were right in the moment/that day, rather than having to wait days/weeks/months/forever to learn if you had done the right things. P.S. I majored in political science P.P.S. ChatGPT-4o just told me that "The use of nerve stimulators for brachial plexus blocks became more widespread in the late 1970s and 1980s." I never used a nerve stimulator — or US — for brachial plexus blocks during my career (I retired in 2015). I guess I was just so used to doing it the way I learned back in the Dark Ages that as long as I got good results, I kept on keeping on. Also, if you're doing a locum in some backwoods hospital in a small town in Virginia, you're unlikely to find a working nerve stimulator, much less a portable ultrasound. I suppose this is why they have a mandatory retirement age for airline pilots.

Would you consider investing in becoming an imaging technologist in today's US healthcare market? IIRC, ultrasound is top of that payscale..?

devilbunny 2y ago
I honestly don’t know anything about that market. We don’t use sonographers because it’s interventional; I need to be able to control my own view very tightly.
citboin 2y ago
Nuclear Medicine Technologists earn more.

meroes 2y ago

Is ultra sound that little monitor they/you look at while the needle thing is in your arm to apply the nerve block? That process a bit unnerving no pun intended. I thought maybe since my arm had been tweaked by being in a full arm cast for a month even with the screen they weren’t going to find it.

devilbunny 2y ago
Yes. You can see the needle, see the tissues. Nerves sometimes aren’t visible right where you want to block them, but if you can see them headed in the right direction and then see the structures they are supposed to be (and usually, though not always, are) near, you can make good guesses and get results.

bookofjoe 2y ago

For perspective, when I learned to do nerve blocks (UCLA Department of Anesthesiology, 1977-1980 residency), portable ultrasound for guidance was a pipe dream. For the axillary approach to brachial plexus blocks, we tried to elicit paresthesias from actual needle impaction on nerves and then pulled back a tad and injected a bolus of anesthetic. We did that repeatedly, aiming to deposit anesthetic near each branch of the plexus. Failing that, hitting the brachial artery with the needle and then continuing to advance the needle until no blood could be aspirated, injecting half the intended volume of anesthetic (2% lidocaine with epinephrine 1:1000) behind the vessel, then withdrawing the needle until no blood could be aspirated and then depositing the remainder of the anesthetic on the front side of the artery was the technique of choice. Diff'rent strokes.

vinay_ys 2y ago
Surprised to find a bunch of anesthesiologists hanging around here. How come?
- bookofjoe 2y ago
  HN is my favorite place on the internet. I only wish I'd discovered it before I stumbled on it in 2016.
- devilbunny 2y ago
  Last time I counted there were three or four of us, but bookofjoe is a prolific reader and poster courtesy of being retired. We have a lot of down time during the day, just in very short increments. Thus the stereotype that we’re all crossword/Sudoku nerds. HN is something you can pick up and put down in a moment. Also, I have always thought of the job as a sort of human engineering, or a big physiology lab. Programmers have REPL; we have vital sign monitors for instant feedback. Thankfully it is difficult to crash a human accidentally. People think doctors bought computers early because they were rich. They could, but it’s worth remembering that if you were a science-and-math kid in the post-WW2 era, medicine and engineering would be the fields you would be pushed toward. That is not as prominent now as tech has started paying better and medicine less, but it’s still not terrible reasoning. I would have to screw up a lot to be unemployable, even if it did take me a lot of school to get to that point. Doctors bought computers because they looked fun. Only one of my partners has an engineering degree (MechE). I majored in chemistry. Two pharmacists, one accountant. Don’t know about the rest.
  - bookofjoe 2y ago
    "I have always thought of the job as a sort of human engineering, or a big physiology lab." I like this. I used to tell med students doing a month-long rotation that the specialty could be described as a combination of applied physiology/applied chemistry/applied anatomy with the great thing being you get to find out if you were right in the moment/that day, rather than having to wait days/weeks/months/forever to learn if you had done the right things. P.S. I majored in political science P.P.S. ChatGPT-4o just told me that "The use of nerve stimulators for brachial plexus blocks became more widespread in the late 1970s and 1980s." I never used a nerve stimulator — or US — for brachial plexus blocks during my career (I retired in 2015). I guess I was just so used to doing it the way I learned back in the Dark Ages that as long as I got good results, I kept on keeping on. Also, if you're doing a locum in some backwoods hospital in a small town in Virginia, you're unlikely to find a working nerve stimulator, much less a portable ultrasound. I suppose this is why they have a mandatory retirement age for airline pilots.