Injury to the lateral cutaneous nerve of forearm after venous cannulation: a case report and literature review.

Venepuncture may be associated with nerve injuries and is commonly performed at the median cubital vein (MCV). Injuries to the superficial radial nerve at the wrist and to the median nerve, anterior and posterior interosseus nerves and medial and lateral cutaneous nerves (LCN) of the forearm at the cubital fossa have been reported. The LCN is a sensory branch of the musculocutaneous nerve and the position of the nerve in relation to the MCV is variable within the cubital fossa. The LCN supplies sensory innervation to the C6 dermatome corresponding to an area of skin overlying the radial border of the forearm. We report the case of a 30-year-old right-handed woman who presented with loss of sensation in the left forearm after donating blood at a transfusion centre. This was due to an injury of the LCN. After 3, 18 and 36 months of follow-up, the sensory deficit had only improved minimally. The lack of recovery of the sensation after 36 months indicates a permanent nerve injury such as neurotmesis rather than neurapraxia of the LCN. A thorough knowledge of the clinical anatomy of the MCV and the LCN, which is highlighted, is essential in preventing venepuncture-associated nerve injury.

A simple, effective and cheap device for the safe irrigation of open traumatic wounds.

This study reports the use of an overturned plastic gallipot from a sterile wound dressing pack as a splashguard during the irrigation of traumatic wounds with a device consisting of a 20 ml syringe and a 21F gauge hypodermic needle. This simple, effective and cheap device can be constructed from items readily available within the emergency department or operating theatre and minimises exposure to biologically hazardous material during wound irrigation.

A case of hyperkalaemia associated with hypocalcaemia.

An 84-year-old woman presented with lethargy and anorexia. Although routine biochemistry demonstrated mild hyponatraemia, moderate hyperkalaemia and severe hypocalcaemia, the patient did not demonstrate the usual symptoms of hypocalcaemia. An electrocardiogram did not demonstrate evidence of hyperkalaemia or hypocalcaemia. Repeated biochemistry confirmed hyponatraemia but that was associated with hypokalaemia and normocalcaemia. Initial management involved correction of the hyponatraemia and hypokalaemia with appropriate intravenous fluids. If serum biochemistry demonstrates hyperkalaemia in association with hypocalcaemia, pseudohyperkalaemia and pseudohypocalcaemia caused by contamination with potassium ethylenediaminetetraacetic acid should always be considered. This can be confirmed by repeating biochemistry, but ensuring the serum gel tube is drawn first when taking multiple blood samples to avoid this contamination.