Today is a 2 parter: 1) The Supraorbital (+supratrochlear) block for forehead lacs and 2) Comments on decision-making
TNF at Ethyl’s 84th and 2nd again, 8 PM
TLDR: The Supraorbital block will save you time and make your life easier/patient happier – WATCH THE 3 MIN VID; We are DECISION MAKERS – make decisions, learn from them, READ THE ATTACHMENT, get ampedTHE SUPRAORBITAL/TROCHLEAR FOREHEAD BLOCKA must-have in your Elmhurst tool belt. PERFECT FOR HEAD LACS.
Forget injecting a million times and ruining the lac borders. With one or two pokes, this block will anesthetize from the upper eyelid to the first 1/3rd of the scalp, from midline to lateral eyebrow. WOH NOW THAT’S BANG FOR YOUR BUCK.
Get about 5 cc’s of your favorite anesthetic, clean the skin around the eyebrow
Poke 1: Insert your needle superficially from lateral to medial along the superior aspect of the eyebrow, aspirate (nothing), and inject 3-5 cc along the eyebrow while pulling out
Poke 2: Find the Supraorbital foramen/notch – have the patient look straight, palpate along the inferior aspect of the eyebrow above the pupils – and inject 1-2 cc anesthetic there.
*** Doing these blocks will create a collection of fluid along the eyebrow, it’s good form to put a finger along the inferior eyebrow and massage in the anesthetic
I asked our own Dr. Avir Mitra for some advice on what he would tell himself when he was starting residency – instead he sent me a pump up speech about decision making and frankly I think that’s way better. I’ve attached it along here and highly suggest everyone takes a minute to read it. Here’s a short blurb:
EM is unique because we’re making big decisions in a paradigm of “imperfect inputs (patients don’t know their history, can’t describe their pain), a lack of full knowledge (you don’t see this condition every day, you’re not the specialist), limited time, and the stakes are high. The ability to sense the shifting probabilities, weigh downstream consequences, understand the larger systems, and ultimately choose the path that is the best combination of bold and safe – this is true executive level decision making. ”
Avir encourages doing something I’ve heard from Dr. Pesyna and other elite decision makers: even if you aren’t 100% sure, commit to a decision before talking to your attending; put your stake in the ground, make that initial decision. Your neural synapses will grow much more quickly this way vs the “welllllll I’m not sure it could be a couple things…what do you think?”