Orthopaedic Surgery/Anaesthesia

While beginning an incision following a bier block the patient states that he can feel you working. You ask for the local and inject to achieve a digital block and soon can proceed with appropriate patient comfort. The procedure complete the splint applied the tourniquet comes down, and low and behold the finger stays white.

This is not the right time to check the bottle, but alas as our assiduous adherence to the trust now one habits of residency slide we ask to see the bottle and note the red label marcaine with epinephrine. The nurse stares blankly as you ask her to fill out an incident report. Another nurse checks the card which indeed calls for plain marcaine.

The finger still pale sorry looking, accusatory, the adjacent fingers mocking in their robust post tourniquet rubor and pulchritudinous splendor. The mind ponders the best approach applying a dab of nitropaste, injecting a bit of papaverine and submerging the finger in warm water as the patient snores away sedated fortunately oblivious to the precarious state of his finger. Finally pink the pulp regains turgor and a bullet dodged.

We return alas to old habits and ask next time to be shown the bottle prior to injecting.

http://emj.bmjjournals.com/cgi/content/full/21/3/387