Page 132 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 5
ED, its effectiveness has been proven extensively.8,13,25 To guarantee efficacy and safety of the blocks in the ED setting, anesthesiologists have trained the EPs and supervised the blocks on request. Therefore, we chose not to compare with traditional treatment strategies but to investigate pain reduction within subjects and explore subjective experiences of both health care providers and patients. Another limitation is the increasing amount of missing data at the 30, 60, and 120 min intervals from baseline. This might be caused by high ED work-load, resulting in incompletely filled-out case report forms, but is mainly due to expeditious pa- tient transfer to the ward or the operating room. Also, there is a risk of bias because the EPs and ED nurses who performed the blocks filled out the case report forms themselves. These limitations can be partly justified because the efficacy of these blocks has been proven in general. In the present study, they have been performed in most (78%) cases by at least two physicians (or residents) and an ED nurse all verifying the correct technique.
Conclusions
In conclusion, this study demonstrates that, through close cooperation between EPs and anesthesiologists, after a one-day training (Dutch), EPs can learn to safely perform ultra- sound-guided nerve blocks in proximal femoral fracture patients in the ED, resulting in effective acute pain relief.
Acknowledgements
We would like to thank all emergency physicians and residents of the Radboud university medical center for participating in the project and their contribution to this paper. We thank Prof. G. J. Scheffer for providing comments on an earlier version of the manuscript.