Reference no: EM133990751

Question

An 86-year-old female brought into the Emergency Department via Ambulance. It is 2100 hours in the evening and there has been hail, wind, and torrential rain since approximately 1830 hours as Perth has experienced a severe storm. The paramedics state that Johanna was outside attempting to move the clothes off the clothesline when she tripped over the washing basket and appears to have a fractured hip. She was unable to get any assistance. An ambulance was called, she remained on the ground until the Ambulance arrived. It is estimated that she was on the ground in poor weather conditions for an estimated 90 minutes. She is currently shivering on the ambulance trolley and has wet and soiled clothes on. Her vital signs are HR: 102 BP: 100/65 RR: 26 T: 35.3 degrees. The paramedics have placed bandages around her hips and knees to attempt to maintain alignment and have given her pain relief. She has a cannula in her right cubital fossa. There is an obvious shortening and rotation of the left leg and Johanna is shivering, grimacing, and calling out. She is in a distressed state.

Johanna needs to go for an urgent x-ray and the Medical Consultant is asking you to prepare the patient for a femoral nerve block. Johanna presented with significant pain on arrival with the paramedics. They had given her some IM Fentanyl for initial pain relief.

Nerve blocks have become a preferred method of pain management for patients with a fractured NOF.

Compare the available pain relief options and discuss why it is evidence-best practice for managing a fractured NOF with a nerve block.