What’s Your Diagnosis? Ultrasound-Guided Pediatric Nerve Blocks in the ED

Welcome to this month’s What’s Your Diagnosis Challenge! But before we begin, check to see if you got last month’s case on Lead Poisoning in Children: Emergency Department Recognition and Management right.

Case Presentation: Ultrasound-Guided Pediatric Nerve Blocks in the Emergency Department: An Evidence-Based Update 

A 12-year-old otherwise healthy girl presents to the ED 2 hours after sustaining a laceration on the sole of her right foot, having cut it on a rock… 

The girl’s most recent tetanus vaccination was 2 years ago. On examination, she has a 3-cm linear laceration on her right heel that is hemostatic and extends into subcutaneous tissue. She has an otherwise normal examination and is neurovascularly intact. You would like to irrigate, explore for foreign body, and perform primary laceration repair; however, you recall that direct local anesthesia infiltration to the sole of the foot is very painful, may be difficult to achieve satisfactory analgesia, and can distort wound margins. What other options do you have? Is there a regional nerve block you can perform to anesthetize this area? 

Make your best guess, and check back next month to find out the correct answer!

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