Top Tweets for #wrongsidedblock

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⚡ 𝐈𝐌𝐌𝐄𝐃𝐈𝐀𝐓𝐄 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 𝐑𝐞��𝐥 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 𝐂𝐎𝐆𝐍𝐈𝐓𝐈𝐕𝐄 ��𝐑𝐀𝐊𝐄 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⚡ 𝐈𝐌𝐌𝐄𝐃𝐈𝐀𝐓𝐄 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 𝐑𝐞��𝐥 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 𝐂𝐎𝐆𝐍𝐈𝐓𝐈𝐕𝐄 ��𝐑𝐀𝐊𝐄 before harm.
👉 Wrong-sided block is a “NEVER event”… but what you do next is a “𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄 𝐝𝐞𝐜𝐢𝐬𝐢𝐨𝐧.”

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