steven rhondeau md co-founder, alliance for international … rhondeau... · j.c.m/ 07-11-18 66 / m...
TRANSCRIPT
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Steven Rhondeau MD
Co-founder, Alliance for International Medicine
Adjunct Assistant Professor Department of Surgery
Center for Global Surgery
University of Utah School of Medicine
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PARTNERSHIP
SUSTAINABLE
MEANINGFUL
PRACTICAL
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Introducing Ultrasound Guided Regional Anesthesia in Resource-Restricted Countries: The AIM Experience
Steven Rhondeau MD
Co-founder, Alliance for International Medicine
Adjunct Assistant Professor Department of Surgery
Center for Global Surgery
University of Utah School of Medicine
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FEMORAL/ SCIATIC
ABDOMINAL WALL
BRACHIAL PLEXUS
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MOST DIFFICULT
MODERATE
LEAST COMPLEX
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Date of Surgery
Age/Gender
Surgical Procedure
Regional Block Performed
Level of Difficulty
Postoperative Pain Score
Complications
Additional Annotations
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Nombre/ Fecha Edad/Sexo Cirugia Bloque Regional Dificultad Cateter de Nervio Grado de Dolor Complicaciones Notas
J.S.G / 02-11-18 13 / MFRACTURA DE TALLO VERDE DE CUBITO Y RADIO DERECHO BLOQUEO INFRACLAVICULAR DERECHO 1 - 0 ANTECEDENTES : ALERGIA PNC
F.F.M / 02-11-18 59/FFRACTURA DE DIAFISIS DE HUMERO DERECHO BLOQUEO SUPRACLAVICULAR DERECHO 2 - 1 ANTECEDENTES : HIPOTIROIDEA/DM2, RAM: METAMIZOL
J.C.M/ 07-11-18 66 / M INJERTO VASCULAR BLOQUEO INTERESCALENICO DERECHO 2 - 3BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO/ ANTECEDENTE: ERC-5
N.C.B/ 08-11-18 64/ M FRACTURA DE HUMERO IZQUIERDOBLOQUEO INFRACLAVICULAR+ INTERESCALENICO IZQUIERDO 2 - 0
J.R.N /08-11-18 05/ MFRACTURA DE RADIO Y CUBITO IZQUIERDO BLOQUEO AXILAR IZQUIERDO 1 - 0 BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO
J.M.L /13-11-18 17 /M FRACTURA DE RADIO DISTAL BILATERAL BLOQUEO INFRACLAVICULAR BILATERAL 2 1 BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO
J.M.L / 15-11-18 17 /M FRACTURA DE RADIO DISTAL BILATERAL BLOQUEO INFRACLAVICULAR DERECHO 1 - 1BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO/ REEINGRESO A SALA DE OPERACIONES PARA LIBERACION DE TUNEL CARPIANO
M.A.R / 15-11-18 62/ F FRACTURA HUMERO PROXIMAL DERECHO BLOQUEO INTERESCALENICO DERECHO 1 - 0
G.O.R/ 16-11-18 60/ F FRACTURA DE CUPULA RADIO IZQUIERDO BLOQUEO INFRACLAVICULAR IZQUIERDO 2 - 0 ANTECEDENTES : HTA/OBESIDAD
J.N.G / 16-11-18 52/ MFRACTURA DE DIAFISIS DE HUMERO DERECHO
BLOQUEO INTERESCALENICO + SUPRACLAVICULAR DERECHO 2 0 ANTECEDENTES : SECUELA DE POLIOMIELITISS+ MPVIMIENTOS COREICOS
F.R.Z / 20-11-18 50/ MFRACTURA DE DIAFISIS DE RADIO IZQUIERDO BLOQUEO INFRACLAVICULAR IZQUIERDO 1 0
F.I.D / 22-11-18 14/ M FRACTURA DE HUMERO IZQUIERDO BLOQUEO INTERESCALENICO IZQUIERDO 1 0 BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO
M.V.V / 26-11-18 22/ M FRACTURA EXPUESTA HUMERO DERECHOBLOQUEO INTERESCALENICO + SUPRACLAVICULAR DERECHO 1 1
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Collected data for 14 months
No blocks were performed for 3 months
135 UGRA blocks performed
5 were partial/incomplete blocks
No failed blocks
No complications
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LOWER EXTREMITY BLOCKS: 22
ABDOMINAL BLOCKS: 4
UPPER EXTREMITY BLOCKS: 109
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BLOCK DIFFICULTY SCALE
1 — Landmarks/needle easily identified and visualized during block
2 — Landmarks/needle mildly difficult to ID and visualize during block
3 — Landmarks/needle moderately difficult to ID and visualize during block
4 — Landmarks/needle very difficult to ID and visualize during block
5 — Block abandoned due to inability to identify landmarks and/or needle
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LOWER EXTREMITY BLOCKS: 1.81
ABDOMINAL BLOCKS: 1.00
UPPER EXTREMITY BLOCKS: 2.67
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PATHWAYS
PRE-MISSION TEACHING —> WORKSHOPS
CULTURAL BARRIERS
STANDARDIZED INTERNATIONAL GUIDELINES
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SURGEON SUPPORT
BLOCKS ABANDONED EARLY
PERPETUATION OF PRACTICES/PROCESSES
LACK OF PROTOCOLS
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RESIDENTS STAYING IN PIURA
PHYSICIANS COMING TO PIURA TO LEARN
ATTRACTING TOP RESIDENTS TO TRAIN
MEDICAL COMMUNITY WORKING TOGETHER TO RAISE THE STANDARD OF CARE
REGIONAL CENTER OF EXCELLENCE
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LOCAL ANESTHETIC $0.60
20 cc SYRINGE $0.18
ULTRASOUND NEEDLE $1.53
NERVE CATHETER $6.00
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NON-OPIOID PAIN MEDICATIONS
IV MAGNESIUM $2.94
IV KETOROLAC $0.88
ORAL GABAPENTIN $0.05
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