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A surgeon friend of mine had been a grunt Marine right out of high school. I asked him, "What is it like to be a Marine?" He said, "Ready!" Not that being ready is a new concept for nurses, but for peripheral nerve blocks, which require so much focus and accuracy, the term is particularly apt. There are inherent dangers in regional anesthesia: seizures, vascular collapse, pneumothorax, sudden loss of consciousness and nerve injury. We need to be ready (Ready!) for all of these possibilities. But what we really need is focus for accurate and safe placement. We need a nurse whose whole attention is on assisting and knowing what to have in hand, what the sequence is, how to adjust the nerve stimulator and the ultrasound, how to properly aspirate the syringe and give the local anesthetic. She also needs to help observe nerve stimulator twitches, improve the image on the ultrasound, and observe hydro-dissection and flow around the target nerve or plexus. We may need to administer more sedation. Read on as we outline 3 challenges that OR nurses must meet when a block patient presents.
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