"On Arrival Block"-Management of Upper Extremity Trauma with Resuscitation in the Operating Room

Area of Science:

• Trauma Care
• Anesthesiology
• Orthopedic Surgery

Background:

• Severe upper extremity injuries require prompt and effective management.
• Traditional trauma protocols involve multiple resuscitation steps, potentially leading to delays and errors.

Purpose of the Study:

• To evaluate the efficacy and benefits of the "On Arrival Block" protocol in managing severely injured upper extremities.
• To highlight the advantages of administering brachial blocks in the operating room prior to emergency department assessment.

Main Methods:

• Implementation of the "On Arrival Block" protocol, involving immediate brachial plexus anesthesia in the operating room.
• Bypassing the emergency department assessment and resuscitation for eligible patients.

Main Results:

• Significant reduction in patient suffering due to immediate pain relief.
• Improved efficiency by avoiding duplicated resuscitation efforts and associated costs.
• Facilitation of pain-free examination and enhanced quality of radiographic imaging.
• The only contraindication identified is suspected brachial plexus injury due to potential total spinal anesthesia.

Conclusions:

• The "On Arrival Block" is a "game changer" in trauma care for upper extremity injuries.
• This protocol optimizes patient care by streamlining the resuscitation process and improving outcomes.
• It necessitates a dedicated setting with resuscitation equipment and availability of senior anesthesiologists and surgeons.