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RCEM Fascia Iliaca Block (FICB) guideline

The Royal College of Emergency Medicine has recently published a Best Practice Guideline1 on the use of fascia iliaca blocks (FIB) in the ED. Whilst national guidance is always welcome in helping to ensure consistent care and change practice for the better, there are a number of parts of this guidance that differ from our normal practice and what we teach. There are also some areas the guideline ignores altogether. In this post we aim to explain why we disagree with some areas of the guideline and fill in some of the gaps. Who should get a block? We are of the opinion that fascia iliaca blocks should form a standard part of the management of pretty much anyone with a fracture of the hip or femur. It may well not totally replace the need for other forms of analgesia but it is a key tool in providing good pain…

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Bladder volume measurement

Measurement of bladder volume is quick and easy to perform. Point-of-care machines will usually have a built in bladder volume calculation. With the patient supine place your transducer transversely just above the pubic symphysis. If the bladder is relatively empty you may need to angle the probe down into the pelvis. Once you have identified the bladder fan the probe back and forth until you find the largest cross-sectional area of the bladder and freeze the image. Enter the calculation function of you machine and select bladder volume. You will find three measurements which need to be taken, length, width and height. These are multiplied together to calculate the volume. Select width and place calipers across the maximum width of the bladder. Save the measurement. It is also good practice to save the image to demonstrate what you have measured. Rotate the probe into a sagittal position and obtain a…

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