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Prepared Physician’s Monthly Pearl of Wisdom for April 2021, Flipping Over Hematoma Blocks

Prepared Physician’s Monthly Pearl of Wisdom for April 2021, Flipping Over Hematoma Blocks 0

Not long ago, one of my colleagues’ ambitious nephews was striving to complete as many mid air flips as possible on the trampoline. After completing seven full flips in the air, he had an awkward landing that resulted in a fracture dislocation of his ankle. 

He arrived in the Emergency Department with his foot twisted laterally and beginning to have a dusky appearance, with his distal capillary refill pushing 10 seconds.

We quickly performed a hematoma block and reduced the ankle and foot back to anatomical position, with nearly no pain. His foot quickly became a healthy color, and his capillary refill was now less than 3 seconds.

Hematoma Block is a reasonable, safe means of anesthesia for simple, closed distal extremity fractures requiring quick reduction maneuvers. Prep the skin over the fracture site with antiseptic solution, confirm needle placement in the fracture hematoma by aspiration of blood. Slowly inject 5-15 mL of plain lidocaine into the fracture cavity and around the associated periosteum. Allow 5-15 minutes for anesthetic effect to be achieved.

Roberts, JA et al. Clinical Procedures in Emergency Medicine and Acute Care, 2019; 536-537.

With Prepared Physician’s Suture Kits, outfitted with Lidocaine and Sam Splint, you can comfortably avoid the complications of neurovascular compromise with quick action, until you can get your injured loved one to definitive Orthopedic care.

Nathan Whittaker, MD

Prepared Physician

  • Brandon Durfee
Prepared Physician’s monthly Pearl of Wisdom for March 2021 Acute onset of gravity

Prepared Physician’s monthly Pearl of Wisdom for March 2021 Acute onset of gravity 0

No matter the season, we all have beloved hobbies and activities that bring us enjoyment. Frequently these same ventures also place us one accidental slip or awkward fall from injury. Simple extremity fractures are among the most common injuries that occur.


Immobilizing such extremity injuries with proper splinting will decrease pain, bleeding and helps avoid additional soft tissue, vascular and neurological injury.

Muttath, et al. Overview of finger, hand and wrist fractures. UpToDate April 2019.


Prepared Physician has Sam Splints available so you can be prepared to reduce the pain and suffering of your loved one’s simple extremity fractures.


Check out what all Prepared Physician has to offer, so you can avoid the Covid congested Emergency Department and be prepared to take care of grandma Ruby or nephew Johnny!


Nathan Whittaker, MD

Prepared Physician 

Prepared Physician’s Monthly Pearl of Wisdom for February 2021: Our friend Crystal, Crystalloid

Prepared Physician’s Monthly Pearl of Wisdom for February 2021: Our friend Crystal, Crystalloid 0

Whether it’s the fallout of your rambunctious college student’s party weekend, or the gloomy revenge of aunt Nancy’s potato salad that was left out on the table too long, managing hypovolemia is part of being a Prepared Physician.


It is recommended that initial fluid replacement be completed with crystalloid solution. This raises the question of which fluid, 0.9% saline or a buffered crystalloid solution, such as lactated ringers. A review of the literature tells us that in small volume resuscitation, less than or equal to 2 L, neither solution has been proven to be consistently superior. With large volume resuscitation, greater than 2 L, this should be an informed decision individualized by factors such as patient chemistries, estimated volume of resuscitation, potential for adverse effects of the solution, as well as facility and physician preference. 
Mandel,MD; P. Palevsky,MD; et al. “Treatment of severe hypovolemia or hypovolemic shock in adults”. Jan 2021 UpToDate.


Prepared Physician has IV hydration kits available with your choice of 0.9% saline or lactated ringers, so you can be prepared for volume resuscitation within the comforts of your usual practice and home! Check out our IV hydration kit options today!


Nathan Whittaker, MD

Prepared Physician 

Prepared Physician’s Pearl of Wisdom for January 2021 Poking where?

Prepared Physician’s Pearl of Wisdom for January 2021 Poking where? 0

When loved ones suffer the onslaught of relentless fluid loss from any cause, the need for intravenous rehydration will quickly arise.


With the quandaries of quarantine confounding easy access to health care, a prepared physician can provide treatment at home with ease and efficiency using our IV hydration kits!


For intravenous access in the upper extremity, the metacarpal and dorsal veins comfortably allow access with 22-20 gauge IV catheters. Accessing these veins still allows functional mobility of the arm while IV access is in place.

For short term IV access, when extremity mobility is not a concern, access of the more proximal cephalic, medial cubital, or basilic veins is appropriate. These veins can accommodate IV catheters sized 22-16 gauge. 

Roberts, JA et al. Clinical Procedures in Emergency Medicine and Acute Care, 2019; 395-396.

Prepared Physician’s IV hydration kits come with 22, 20, and 18 gauge IV catheters, so you are prepared for any scenario.


Check out Prepared Physician’s great options for IV Hydration Kits and be prepared for any illness to strike!


Nathan Whitaker, MD

Prepared Physician

Provider Prepared's Weekly Pearl of Wound Wisdom #35 Mental Nerve how to

Provider Prepared's Weekly Pearl of Wound Wisdom #35 Mental Nerve how to 0

For facial wounds located in the lower lip, inferior to the lower lip, and chin area a mental nerve block is appropriate for anesthesia.

The mental nerve exits the mental foramen within the mandible. It is located in line with the infraorbital and supraorbital foramen. We prefer using the intraoral approach for this nerve block.

Palpate the mental foramen, using a 25 or 27 gauge needle, insert the needle just medial to the mental foramen, directed toward the foramen at the inferior gum line. If the patient experiences any paresthesia withdraw the needle until the symptoms resolve. Inject 2mL of anesthetic into this location. With wounds that are near the midline, a bilateral block will need to be performed to achieve sufficient anesthesia.

 Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.

Provider Prepared Laceration Repair Kits with Lidocaine will have you prepared at home and on the go for facial laceration anesthesia and repair!

Provider Prepared

Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared's Weekly Pearl of Wound Wisdom # 34 Infraorbital how to

Provider Prepared's Weekly Pearl of Wound Wisdom # 34 Infraorbital how to 0

For anesthesia of the medial cheek, lateral nose, upper lip and lower eye lid, infraorbital nerve block is appropriate. We recommend the intra-oral approach for infraorbital nerve blocks.

Landmarks for the nerve block are: the second bicuspid, the pupil with a straight forward gaze and the inferior bony otrbit notch. The infraorbital foramen is located in the mid portion of the zygomatic arch, inline with these landmarks, and frequently can be palpated.

For an intraoral approach; insert a 27 or 25 gauge needle through the gum line, oriented in line with these landmarks at the second bicuspid, directed toward the infraorbital foramen. Keep a finger at the infraorbital foramen, when the pressure of the needle is palpated stop advancing the needle. If the patient develops paresthesia withdraw the needle a short distance until paresthesia resolves. Inject 1-2 mL of anesthestic in to this area.

Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.

Provider Prepared Laceration Repair Kits with Lidocaine will have you prepared at home and on the go for facial laceration anesthesia and repair.

Provider Prepared

Nathan Whittaker, MD

  • Brandon Durfee