Emergency Medicine Cases EM Quick Hits 65 Occipital Nerve Block, PoCUS in Pulmonary Embolism, Myelopathy, Team Resuscitation, Incidental Neutropenia, Peer Programs
Jun 3, 2025
Ian Chernoff, a physician from Sina Health Sciences, shares how POCUS enhances the management of sick pulmonary embolism patients. Brit Long dives into incidental neutropenia, demystifying its causes and patient care approaches. Mathew MacArther provides insights on occipital nerve blocks, detailing their indications and execution for headache relief. Kylie Booth discusses the Ontario Health Peer-to-Peer Program, emphasizing its role in supporting emergency physicians in rural settings through collaboration and expert support.
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Occipital Nerve Block Success Story
- A woman with occipital neuralgia had stabbing scalp pain and allodynia, unrelieved by meds, and hadn’t slept for days.
- Dr. Matthew MacArthur performed a left occipital nerve block which relieved her pain completely within minutes.
When and How to Do Occipital Blocks
- Offer occipital nerve block to patients with occipital neuralgia or refractory occipital migraine after first-line treatments.
- Use 3cc of 2% lidocaine, consider unilateral or bilateral block depending on headache distribution.
Performing Occipital Nerve Blocks
- Palpate landmarks like occipital protuberance and mastoid process and inject lidocaine perpendicular above the superior nuchal line.
- Inject at nerve location plus 1cm medial and lateral to maximize chance of nerve anesthesia safely.