hi there this is dr greg hickman from the anders institute uh we've got a young lady here with a radius fracture we're gonna get fixed up today for her and uh we're just gonna go do an axillary block on her these will set up really fast they work really well they're really easy it's very superficial very easy to see with our clarius ultrasound and just have to be real careful with the veins there's a lot of veins in this area and there's a couple ways to do it we like to go find all the nerves stimulate them with the nerve stimulator and uh and then inject a little local around each one another way you can do it you can just surround the artery the axillary artery with with local anesthetic and and and that should get all those nerves for you but like i said we're going to stimulate and we always stimulate here we feel like that's just an added benefit to our ultrasound and we'll get started and see what it looks like you can see the artery right in the middle of the screen beating i'm going to turn the uh gain up just a little bit so you can see what we got going on here i think that's the musculocutaneous kind of way out there so we're gonna come in from the right side okay so we're going to come in here first thing i think this is the musculataneous right here yep that's the musculocutaneous nerve you saw that twitch so we're going to put some local right there give me a couple rocky all right let me go under it here all right so you see how easy i got to twitch before and then i'm right up next to it we're not going to twitch anymore just depends on where you are okay give me a couple more right there and one more right there then we're gonna go past that and go down deep to the artery see if we can find the radial nerve you see our approach coming in and sometimes the radial nerve is a little past the artery so what we'll do is we'll just put some local hair under the artery open up this space and that should stretch around to the radial nerve and then we'll go up on on top of the artery and put some more when we get the median and ulnar nerves so give me five right here rocky there we go so that's really good spread there around the artery from about eight o'clock to about five o'clock so that's good then we're going to go back up here on top see if we can find the median nerve should be about right there not getting a twitch okay let me go over the top of that there's our twitch so let's get it back up here hold that arm about like that okay there we go so there's a median twitch right there give me five rocky so what that'll do they'll push the nerve out of the way so you can advance your knee a little bit more then we'll come back and go under that nerve closer to the artery give me about three right there we'll put three on the underside i got a little twitch again two and three and then we're gonna advance on back and find the ulnar nerve posteriorly that should be right back here there we go the arm back up here there's our ulnar twitch you give me five right back there rocky [Music] we use a total of 30 cc's got a nice circle the axillary artery so that's our axillary block for today we'll get her set up for surgery and i'd like to thank you all very much for watching these blocks uh just showing the beauty of this this wireless system the convenience of this is so easy if you're in a solo practice or all md practice and you want to carry this around with you it's very easy to do and i'd highly recommend this clarisse system thank you you
