US Guided Femoral Nerve Blocks & Pre-hospital Epinephrine in Cardiac Arrest Patients

This month Dr. Byars will be moderating JC and unsurprisingly, our ultrasound and EMS guru selected two US and one EMS article that are recent publications and should generate much discussion. There has been observational data in support of the use of femoral nerve blocks in patients with acute hip fractures for quite some time. This procedure may mitigate the harms associated with both over and under-dosing these patients with parenteral narcotics. In the hands of an expert this procedure seems to be a “no brainer”. That stated, is this data compelling enough to suggest a mandate that all EM clinicians pursue competency in the femoral nerve block and if so, how do we get there? In addition, we will be reviewing a recent RCT in the NEJM article from the UK that compares epinephrine to placebo in out of hospital cardiac arrest. This is a large trial of over 8000 patients and provides some data that I am certain will engender lots of good discussion.  

 Ritcey B Regional Nerve Blocks For Hip and Femoral Neck Fractures in the Emergency Department: A Systematic Review CJEM. 2016 Jan;18(1):37-47.  Appraisal

Beaudoin FL A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91. Appraisal

Perkins GD A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018 Aug 23;379(8):711-721. Appraisal