Top Tweets for #edRa

9 days ago

via @freerussiaorg 🔴 Video "🚫 Non esiste una Russia unita! 🚫 Sappiamo tutti che questa 'vittoria' non è reale, ma truccata. Sappiamo tutti che #Edra non ha la maggioranza. 1/

236

Italy in Norway and Iceland @ItalyinNOR_ISL

26 days ago

🇮🇹 🇳🇴 Ambassadør Andrea Cavallari møtte i dag Niccolò Mazzei og Franca Altieri fra #Edra, et av de mest spennende navnene innen moderne italiensk #møbeldesign. De er i #Oslo for å delta på Designfestivalen på #Skøyen, Oslos spennende designdistrikt.

ItalyinNOR_ISL's tweet photo. 🇮🇹 🇳🇴 Ambassadør Andrea Cavallari møtte i dag Niccolò Mazzei og Franca Altieri fra #Edra, et av de mest spennende navnene innen moderne italiensk #møbeldesign. De er i #Oslo for å delta på Designfestivalen på #Skøyen, Oslos spennende designdistrikt. https://t.co/ijh8aEhXPK

536

aimei @aimei_art

4 months ago

本町エリアのイタリアの家具メーカー #Edra と #スタジオカンパーナの展示、すごく楽しかった…！様々なデザインの椅子の座り比べやスタジオカンパーナのドキュメンタリー映画を観ました🎬✨ 期間は明日までとのことなのでお時間合えばぜひ🌱 #OsakaArtDesign2026

aimei_art's tweet photo. 本町エリアの
イタリアの家具メーカー #Edra と
#スタジオカンパーナの展示、
すごく楽しかった…！

様々なデザインの椅子の座り比べや
スタジオカンパーナの
ドキュメンタリー映画を観ました🎬✨

期間は明日までとのことなので
お時間合えばぜひ🌱

#OsakaArtDesign2026 https://t.co/iLt9sRewFs

193

Dr.Kartik Sonawane

@KartikBSonawane

5 months ago

🎯 𝐌𝐀𝐒𝐓𝐄𝐑𝐈𝐍𝐆 “𝐀𝐏𝐏𝐑𝐎𝐀𝐂𝐇 𝐓𝐎 𝐀 𝐏𝐀𝐓𝐈𝐄𝐍𝐓 ” 𝐈𝐍 𝐄𝐗𝐀𝐌𝐒 (𝐖𝐑𝐈𝐓𝐓𝐄𝐍/𝐕𝐈𝐕𝐀)- 𝐒𝐭𝐫𝐮𝐜𝐭𝐮𝐫𝐞𝐝 𝐀𝐧𝐬𝐰𝐞𝐫 𝐁𝐥𝐮𝐞𝐩𝐫𝐢𝐧𝐭📝 #RegionalAnesthesia #EDRA #ApproachToAPatient #PerioperativeMedicine #OrthopedicAnesthesia #HighRiskPatient #MultimodalAnalgesia #ERAS #VivaPrep #AnesthesiaEducation #TipOfTheDay #MyRATips 𝐓𝐢𝐩 𝐨𝐟 𝐭𝐡𝐞 𝐃𝐚𝐲 : How to answer 𝐂𝐎𝐌𝐏𝐋𝐄𝐗 𝐂𝐀𝐒𝐄 𝐒𝐂𝐄𝐍𝐀𝐑𝐈𝐎 questions: Managing IHD ❤️ | DM 🍬 | Thyroid 🦋 | CKD 🩺 | Frailty 👴 | Anticoagulants 💉 | Difficult airway 😮‍💨 patients for hip 🦴 | knee 🦵 | shoulder 💪 | trauma 🚑 surgery requires a 𝐏𝐀𝐓𝐈𝐄𝐍𝐓 𝐉𝐎𝐔𝐑𝐍𝐄𝐘 – 𝐁𝐀𝐒𝐄𝐃 𝐏𝐄𝐑𝐈𝐎𝐏𝐄𝐑𝐀𝐓𝐈𝐕𝐄 𝐒𝐓𝐑𝐀𝐓𝐄𝐆𝐘. 🔍 𝟏. 𝐊𝐍𝐎𝐖 𝐘𝐎𝐔𝐑 𝐏𝐀𝐓𝐈𝐄𝐍𝐓 🎯 𝐂𝐨𝐫𝐞 𝐅𝐨𝐜𝐮𝐬: 🔹 Age & functional reserve 🔹 Comorbidities & organ status 🔹 Airway + spine challenges 🔹 Surgical blood loss risk 🔹 Medication profile 🔹 Frailty / rehabilitation potential 💊 𝟐. 𝐌𝐄𝐃𝐈𝐂𝐀𝐓𝐈𝐎𝐍 𝐌𝐀𝐒𝐓𝐄𝐑𝐘 ✅ 𝐂𝐨𝐧𝐭𝐢𝐧𝐮𝐞: 🔹 Beta blockers 🔹 Statins 🔹 Thyroid meds 🔹 Antianginals ⚠️ 𝐎𝐩𝐭𝐢𝐦𝐢𝐳𝐞 / 𝐇𝐨𝐥𝐝: 🔹 Diabetic drugs 🔹 Anticoagulants (ASRA guided) 🔹 Antiplatelets 🔹 Selected antihypertensives 🛡️ 𝐑𝐮𝐥𝐞: Balance thrombosis vs bleeding risk 🌙 𝟑. 𝐍𝐈𝐆𝐇𝐓 𝐁𝐄𝐅𝐎𝐑𝐄 𝐒𝐔𝐑𝐆𝐄𝐑𝐘 𝐆𝐨𝐚𝐥𝐬: 🔹 Anxiety reduction 😌 🔹 Better sleep 💤 🔹 Preemptive analgesia 💊 🔹 Stress suppression 📉 🚑 𝟒. 𝐎𝐍 𝐀𝐑𝐑𝐈𝐕𝐀𝐋 𝐁𝐋𝐎𝐂𝐊 = First Physiologic Intervention 🎯 𝐁𝐞𝐧𝐞𝐟𝐢𝐭𝐬: 🔹 Rapid pain relief 🔹 Blunts stress response 🔹 Stabilizes hemodynamics 🔹 Prevents sugar surge 🔹 Reduces immune suppression 🔹 Builds patient trust 🔹 Facilitates positioning 💡 𝐌𝐚𝐧𝐭𝐫𝐚: Analgesia First, Surgery Next. 🎯 𝟓. 𝐏𝐑𝐄𝐄𝐌𝐏𝐓𝐈𝐕𝐄 𝐁𝐋𝐎𝐂𝐊 🔹 Continuum of care 🔹 Easier neuraxial positioning 🔹 Reduced opioid need 🔹 Better intraoperative stability 🔹 Reduced central sensitization ⚡ 𝟔. 𝐈𝐍𝐓𝐑𝐀𝐎𝐏𝐄𝐑𝐀𝐓𝐈𝐕𝐄 𝐏𝐑𝐄𝐂𝐈𝐒𝐈𝐎𝐍 𝐂𝐡𝐨𝐨𝐬𝐞 𝐰𝐢𝐬𝐞𝐥𝐲: 🟢 RA | 🔵 GA | 🟣 GA + RA 🔹 Hemodynamic preservation 🔹 Cerebral perfusion maintenance 🔹 Blood loss management 🔹 Temperature & glucose control 🔹 Multimodal analgesia 🩹 𝟕. 𝐏𝐎𝐒𝐓𝐎𝐏𝐄𝐑𝐀𝐓𝐈𝐕𝐄 𝐒𝐔𝐂𝐂𝐄𝐒𝐒 𝐁𝐥𝐨𝐜𝐤 𝐠𝐨𝐚𝐥𝐬: 🔹 Dermatomes 🔹 Osteotomes 𝐄𝐑𝐀𝐒 𝐩𝐫𝐢𝐨𝐫𝐢𝐭𝐢𝐞𝐬: 🔹 Early mobilization 🚶 🔹 DVT prophylaxis 🛡️ 🔹 PONV prevention 🤢 🔹 Rehab enhancement 💪 🔹 Opioid minimization 🧠 𝟖. 𝐑𝐀 = 𝐉𝐎𝐔𝐑𝐍𝐄𝐘, 𝐍𝐎𝐓 𝐏𝐑𝐎𝐂𝐄𝐃𝐔𝐑𝐄 𝐑𝐀 𝐬𝐮𝐩𝐩𝐨𝐫𝐭𝐬: 🔹 Arrival stabilization 🔹 Preemptive analgesia 🔹 Intraoperative physiology 🔹 Postoperative recovery 🧠 𝟗. 𝐇𝐎𝐖 𝐭𝐨 𝐈𝐌𝐏𝐑𝐄𝐒𝐒 𝐄𝐗𝐀𝐌𝐈𝐍𝐄𝐑𝐒 Always: 🔹 Be sequential 🔹 Be patient-centric 🔹 Use headings 🔹 Mention safety 🔹 Justify decisions 🔹 Include guidelines 🛡️ 𝐏𝐨𝐰𝐞𝐫 𝐊𝐞𝐲𝐰𝐨𝐫𝐝𝐬: ASRA • ERAS • MMA • DVT • PONV • Early Mobilization • PROSPECT Guidelines. ✍️ 𝟏𝟎. 𝐅𝐎𝐑 𝐖𝐑𝐈𝐓𝐓𝐄𝐍 𝐄𝐗𝐀𝐌 Use: 🔹 Flowcharts 🔹 Bullet points 🔹 Tables 🔹 Mnemonics 🔹 Structured headings 🔥 𝐅𝐈𝐍𝐀𝐋 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 🏆 𝐆𝐨𝐥𝐝𝐞𝐧 𝐅𝐨𝐫𝐦𝐮𝐥𝐚: Follow the Patient Journey Admission ➝ Optimization ➝ Planning ➝ OT ➝ Recovery ➝ Discharge 🎤 𝐅𝐨𝐫 𝐕𝐢𝐯𝐚, 𝐒𝐩𝐞𝐚𝐤 𝐥𝐢𝐤𝐞: Clinician + Academician + Regional Anesthetist 🚀 𝐓𝐨𝐩𝐩𝐞𝐫’𝐬 𝐅𝐨𝐫𝐦𝐮𝐥𝐚: Knowledge + Structure + Clinical Judgment + Presentation = High Score 🏅 A great answer is not about 𝐖𝐑𝐈𝐓𝐈𝐍𝐆 more, it is about 𝐆𝐔𝐈𝐃𝐈𝐍𝐆 the examiner smoothly through the patient’s journey.

418

Dr.Kartik Sonawane

@KartikBSonawane

5 months ago

�� 𝐖𝐑𝐎𝐍𝐆-𝐒𝐈𝐃𝐄𝐃 𝐁𝐋𝐎𝐂𝐊: 𝐃𝐨𝐧’𝐭 𝐉𝐮𝐬𝐭 𝐌𝐚𝐧𝐚𝐠𝐞 𝐈𝐭 - 𝐂𝐨𝐧𝐭𝐚𝐢𝐧, 𝐃𝐢𝐬𝐜𝐥𝐨𝐬𝐞, 𝐋𝐞𝐚𝐫𝐧 #WrongSidedBlock #NeverEvent #RegionalAnesthesia #PatientSafety #StopBeforeYouBlock #HumanFactors #EDRA #SafetyFirst #ThinkBeforeYouBlock #GrayZonesInRA #GrayAreasInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: 1️⃣ 🎯 𝐖𝐡𝐲 𝐈𝐭𝐬 𝐚 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄? ⚠️ The event = black & white (wrong side → error) 🧠 The response = decision-making under uncertainty ⚖️ Proceed vs postpone surgery? 💉 Can you safely perform the correct-side block (dose limits)? 🫀 Risk of LAST after cumulative dosing? 🔄 Switch to GA or modify technique? 📊 Patient-specific factors (age, comorbidities, block type) 👉 No single guideline gives a fixed answer → requires clinical judgment 2️⃣⚡ 𝐈𝐌𝐌𝐄𝐃��𝐀𝐓𝐄 𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐄: “𝐒𝐭𝐨𝐩 𝐭𝐡𝐞 𝐂𝐡𝐚𝐢𝐧” 🛑 Stop further injection immediately if wrong side/site is recognized during the block. 📣 Call for senior help and inform the surgical, anesthesia, & nursing team. 🧾 Document exactly what was injected: drug, dose, concentration, volume, time, side, block type, & patient status. 👁️ Monitor closely for LAST, excessive bilateral block effects, respiratory compromise, motor weakness, or evolving neurological symptoms. 🚫 Do not proceed casually with the correct-sided block; reassess cumulative LA dose, urgency of surgery, patient risk, & alternative anaesthetic plan. 3️⃣ 🧠 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐃𝐄𝐂𝐈𝐒𝐈𝐎𝐍: 𝐏𝐫𝐨𝐜𝐞𝐞𝐝, 𝐌𝐨𝐝𝐢𝐟𝐲, 𝐨𝐫 𝐀𝐛𝐚𝐧𝐝𝐨𝐧 ⚖️ Recalculate the remaining safe LA dose before any further block. 🔄 Modify the plan if needed: lower dose, different technique, catheter strategy, GA, local infiltration, or surgical postponement. 🧪 Treat it as a safety event, not just a technical error. 🫀 Ensure lipid rescue and resuscitation equipment are immediately available if further LA is considered. 4️⃣ 💬 𝐃𝐈𝐒𝐂𝐋𝐎𝐒𝐔𝐑𝐄: 𝐇𝐨𝐧𝐞𝐬𝐭, 𝐄𝐚𝐫𝐥𝐲, 𝐂𝐨𝐦𝐩𝐚𝐬𝐬𝐢𝐨𝐧𝐚𝐭𝐞 🤝 Inform the patient once clinically safe. 🗣️ Explain clearly: what happened, what was given, expected effects, monitoring plan, and impact on surgery. 🙏 Offer apology without blame-shifting. 📌 Escalate according to institutional duty of candour / incident reporting pathways. 5️⃣ 🧩 𝐂𝐀𝐔𝐒𝐄𝐒: 𝐓𝐡𝐞 𝐔𝐬𝐮𝐚𝐥 𝐓𝐫𝐚𝐩𝐬 👉 Wrong-sided nerve block is rare but serious and is classified as a “𝐍𝐄𝐕𝐄𝐑 𝐄𝐕𝐄𝐍𝐓”. 👉 Published estimates range from 𝟎.𝟓𝟐 𝐭𝐨 𝟓.𝟎𝟕 per 10,000 blocks. 👉 It may increase risk of nerve injury, LA toxicity, & even wrong-site surgery. 🌀 Distraction during block performance ⏱️ Time pressure and list changes 🔁 Patient repositioning 👥 More than one block 👁️ Surgical mark absent, hidden, or not rechecked 🧠 “Checklist done earlier” illusion 🔇 Poor team culture where people hesitate to speak up 6️⃣ 🛡️ 𝐏𝐑𝐄𝐕𝐄𝐍𝐓𝐈𝐎𝐍: 𝐌𝐚𝐤𝐞 𝐭𝐡𝐞 𝐋𝐚𝐬𝐭 𝐂𝐡𝐞𝐜𝐤 𝐭𝐡𝐞 𝐑𝐞𝐚𝐥 𝐂𝐡𝐞𝐜𝐤 🛑 Stop Before You Block must occur immediately before every new needle insertion, not at consent, not at WHO sign-in, not five minutes earlier. 👀 Visualize the surgical arrow/site mark immediately before needle insertion. 🗣️ Ask the conscious patient to confirm the operative side; if unconscious, recheck consent & operative documentation. 🔁 Repeat the check if the patient is repositioned or if more than one block is performed. 🧑‍🤝‍🧑 Use a two-person stop moment. 🧪 Consider “𝐌𝐎𝐂𝐊 𝐁𝐄𝐅𝐎𝐑𝐄 𝐁𝐋𝐎𝐂𝐊": touch the intended side with an empty syringe & confirm aloud with the team. 🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 🛑 Wrong side? Stop the block. Right response? Stop the harm. 👁️ The mark must be seen - not assumed. 🧠 The checklist is not the safety step; the behaviour is. ⚖️ After a wrong-sided block, the next injection is a new risk decision. 🔥 Stop Before You Block is not a slogan - it is the last 𝐂𝐎��𝐍𝐈𝐓𝐈𝐕𝐄 𝐁𝐑𝐀𝐊𝐄 before harm. 👉 Wrong-sided block is a “NEVER event”… but what you do next is a “𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄 𝐝𝐞𝐜𝐢𝐬𝐢𝐨𝐧.”

KartikBSonawane's tweet photo. �� 𝐖𝐑𝐎𝐍𝐆-𝐒𝐈𝐃𝐄𝐃 𝐁𝐋𝐎𝐂𝐊: 𝐃𝐨𝐧’𝐭 𝐉𝐮𝐬𝐭 𝐌𝐚𝐧𝐚𝐠𝐞 𝐈𝐭 - 𝐂𝐨𝐧𝐭𝐚𝐢𝐧, 𝐃𝐢𝐬𝐜𝐥𝐨𝐬𝐞, 𝐋𝐞𝐚𝐫𝐧

#WrongSidedBlock #NeverEvent #RegionalAnesthesia #PatientSafety #StopBeforeYouBlock #HumanFactors #EDRA #SafetyFirst #ThinkBeforeYouBlock
#GrayZonesInRA #GrayAreasInRA

𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀:

1️⃣ 🎯 𝐖𝐡𝐲 𝐈𝐭𝐬 𝐚 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄?

⚠️ The event = black & white (wrong side → error)
🧠 The response = decision-making under uncertainty

⚖️ Proceed vs postpone surgery?
💉 Can you safely perform the correct-side block (dose limits)?
🫀 Risk of LAST after cumulative dosing?
🔄 Switch to GA or modify technique?
📊 Patient-specific factors (age, comorbidities, block type)

👉 No single guideline gives a fixed answer → requires clinical judgment

2️⃣⚡ 𝐈𝐌𝐌𝐄𝐃��𝐀𝐓𝐄 𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐄: “𝐒𝐭𝐨𝐩 𝐭𝐡𝐞 𝐂𝐡𝐚𝐢𝐧”

🛑 Stop further injection immediately if wrong side/site is recognized during the block.

📣 Call for senior help and inform the surgical, anesthesia, & nursing team.

🧾 Document exactly what was injected: drug, dose, concentration, volume, time, side, block type, & patient status.

👁️ Monitor closely for LAST, excessive bilateral block effects, respiratory compromise, motor weakness, or evolving neurological symptoms.

🚫 Do not proceed casually with the correct-sided block; reassess cumulative LA dose, urgency of surgery, patient risk, & alternative anaesthetic plan.

3️⃣ 🧠 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐃𝐄𝐂𝐈𝐒𝐈𝐎𝐍: 𝐏𝐫𝐨𝐜𝐞𝐞𝐝, 𝐌𝐨𝐝𝐢𝐟𝐲, 𝐨𝐫 𝐀𝐛𝐚𝐧𝐝𝐨𝐧

⚖️ Recalculate the remaining safe LA dose before any further block.

🔄 Modify the plan if needed: lower dose, different technique, catheter strategy, GA, local infiltration, or surgical postponement.

🧪 Treat it as a safety event, not just a technical error.

🫀 Ensure lipid rescue and resuscitation equipment are immediately available if further LA is considered.

4️⃣ 💬 𝐃𝐈𝐒𝐂𝐋𝐎𝐒𝐔𝐑𝐄: 𝐇𝐨𝐧𝐞𝐬𝐭, 𝐄𝐚𝐫𝐥𝐲, 𝐂𝐨𝐦𝐩𝐚𝐬𝐬𝐢𝐨𝐧𝐚𝐭𝐞

🤝 Inform the patient once clinically safe.

🗣️ Explain clearly: what happened, what was given, expected effects, monitoring plan, and impact on surgery.

🙏 Offer apology without blame-shifting.

📌 Escalate according to institutional duty of candour / incident reporting pathways.

5️⃣ 🧩 𝐂𝐀𝐔𝐒𝐄𝐒: 𝐓𝐡𝐞 𝐔𝐬𝐮𝐚𝐥 𝐓𝐫𝐚𝐩𝐬

👉 Wrong-sided nerve block is rare but serious and is classified as a “𝐍𝐄𝐕𝐄𝐑 𝐄𝐕𝐄𝐍𝐓”.
👉 Published estimates range from 𝟎.𝟓𝟐 𝐭𝐨 𝟓.𝟎𝟕 per 10,000 blocks.
👉 It may increase risk of nerve injury, LA toxicity, & even wrong-site surgery.

🌀 Distraction during block performance
⏱️ Time pressure and list changes
🔁 Patient repositioning
👥 More than one block
👁️ Surgical mark absent, hidden, or not rechecked
🧠 “Checklist done earlier” illusion
🔇 Poor team culture where people hesitate to speak up

6️⃣ 🛡️ 𝐏𝐑𝐄𝐕𝐄𝐍𝐓𝐈𝐎𝐍: 𝐌𝐚𝐤𝐞 𝐭𝐡𝐞 𝐋𝐚𝐬𝐭 𝐂𝐡𝐞𝐜𝐤 𝐭𝐡𝐞 𝐑𝐞𝐚𝐥 𝐂𝐡𝐞𝐜𝐤

🛑 Stop Before You Block must occur immediately before every new needle insertion, not at consent, not at WHO sign-in, not five minutes earlier.

👀 Visualize the surgical arrow/site mark immediately before needle insertion.

🗣️ Ask the conscious patient to confirm the operative side; if unconscious, recheck consent & operative documentation.

🔁 Repeat the check if the patient is repositioned or if more than one block is performed.

🧑‍🤝‍🧑 Use a two-person stop moment.

🧪 Consider “𝐌𝐎𝐂𝐊 𝐁𝐄𝐅𝐎𝐑𝐄 𝐁𝐋𝐎𝐂𝐊": touch the intended side with an empty syringe & confirm aloud with the team.

🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒

🛑 Wrong side? Stop the block. Right response? Stop the harm.
👁️ The mark must be seen - not assumed.
🧠 The checklist is not the safety step; the behaviour is.
⚖️ After a wrong-sided block, the next injection is a new risk decision.
🔥 Stop Before You Block is not a slogan - it is the last 𝐂𝐎��𝐍𝐈𝐓𝐈𝐕𝐄 𝐁𝐑𝐀𝐊𝐄 before harm.
👉 Wrong-sided block is a “NEVER event”… but what you do next is a “𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄 𝐝𝐞𝐜𝐢𝐬𝐢𝐨𝐧.”

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