- Most clinically applicable excerpts from NYSORAs best selling textbooks. The economic burden of trauma exceeds 400 billion in the United States annually. This app offers easy-to-digest lessons, peer discussions, and regular updates, making it an essential. GON blocks are effective not only in the treatment of occipital neuralgia, which is a relatively rare pathology, but. Cervical Nerve Root Block. A new technology, SAFIRA SAFer Injection for Regional Anesthesia, provides benefits for the regional anesthesia process which could help create time and cost savings for healthcare providers, whilst promoting better outcomes for clinicians and their patients. NYSORA Tips. Patient-controlled analgesia (PCA) and epidural analgesia are more effective in elderly patients than most other conventional (PO and IM) opioid analgesic regimens. The economic burden of trauma exceeds 400 billion in the United States annually. Cervical Zygapophyseal (Facet) Intra-Articular Injection 3. An equipment cart should contain all of the drugs, needles, and catheters necessary for regional anesthesia as well as resuscitation medications and equipment. Anatomy The sacroiliac joint (SIJ) is a true diarthrodial joint with the articular surfaces of the sacrum and ilium separated by a joint space enclosed in a fibrous capsule 1. NYSORA Tips. Read this chapter of NYSORA Textbook of Regional Anesthesia and Acute Pain Management online now, exclusively on AccessAnesthesiology. The sacral canal contains the cauda equina (including the filum terminale), the spinal meninges, adipose tissue, and sacral venous plexus. 2585 Broadway, Suite 183, New York, NY 10025. This terminology has been officially adopted in the International Classification of Headache Disorders and is used in this section. Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery a single-center double-blinded randomized comparative trial. NYSORA Tips. The incidence of phrenic nerve palsy following STB. The erector spinae plane block (ESP) block is typically performed with the patient in an upright position in the preoperative holding area a. NYSORA SIMULATORS are designed for durability, ease of transportation and storage. The 9th NYSORA International Symposium is the must-attend meeting for advances in Regional Anesthesia, Pain, and Perioperative. Here are 4 steps to successfully perform a rectus sheath block Place the transducer in a transverse orientation above the umbilicus, 1 cm lateral to the midline. For any additional questions contact us at nerveblocksappnysora. An ideal continuous regional anesthesia infusate and administration strategy should provide reliable analgesia with minimal adverse effects. B Cobb angle of 50. Anatomically, a peripheral nerve is always located in the vicinity of an artery between fascial layers. NYSORA, Inc. Imaging in Interventional Pain Management. With the Regional Anesthesia Manual e-Course, not only do we incorporate necessary visuals, and videos, but we also offer real-time updates making obsolete information a thing of the past. Massive transfusion protocols MTPs. With the Regional Anesthesia Manual e-Course, not only do we incorporate necessary visuals, and videos, but we also offer real-time updates making obsolete information a thing of the past. Ultrasound waves are characterized by a specific frequency (f) and wave length (), as described by the equation v f &215; , where v is the speed at which the wave travels (all machines assume that US waves travel through soft tissue at 1540 ms). Using SAFIRA, an anesthesiologist can conduct the regional block themselves. The sympathetic fibers for the head, neck, upper limbs, and heart arise from the first few. Oral and Maxillofacial Surgery. An INR of 1. Veins are becoming visible at the dorsum of the wrist and hand. A high-frequency linear probe is utilized to scan the suprapatellar and. Regional Anesthesia Manual e-Course is a revolutionary learning platform loaded with visuals and tips, and you can make your own scripts and prepare for the course. Local and regional anesthetic techniques has largely replaced general anesthesia. The muscles change their size and profile during their craniocaudal course alongside. Nerve Blocks of the Face. NYSORA Tips. FIGURE 1. 5 lidocaine, the highest sensory dermatome level reached was below T10. A good history and high level of suspicion are required to make the diagnosis. Outpatient surgical procedures have become more complex, and patients are presenting for surgery with a greater number of comorbid conditions than in the past. The history of the rectus sheath block (RSB) dates to 1899 when it was first described by Schleich as a technique that results in muscle relaxation and analgesia to the abdominal wall through blockade of thoracolumbar nerves within the substance of the rectus abdominis muscle (RAM). Cervical Zygapophyseal (Facet) Intra-Articular Injection 3. NYSORA Learning System offers courses on various topics of regional anesthesia, such as fascial plane blocks, lower extremity blocks, thoracic fascial plane blocks, and more. Sonoanatomy of the anterior, lateral, medial, and posterior knee, varus and valgus tests, and flexion and extension tests in different patient positions. If sufficient local anesthetic penetrates the external intercostal muscles, a PEC II block can also block the anterior branch of T2-4 spinal nerves, although this cannot be guaranteed. A new technology, SAFIRA SAFer Injection for Regional Anesthesia, provides benefits for the regional anesthesia process which could help create time and cost savings for healthcare providers, whilst promoting better outcomes for clinicians and their patients. 145,075 likes &183; 1,105 talking about this &183; 292 were here. Local myelin damage with the nerve still intact. NYSORA Tips. Massive transfusion protocols MTPs. With the introduction of propofol, intravenous techniques are. 145,075 likes 1,105 talking about this 292 were here. Clonidine added to the axillary brachial plexus block delayed the onset of pain twofold, without adverse effects when compared with systemic control. Zoran Hadzic, a leading expert in regional anesthesia and pain medicine. The Anesthesia Summit brings together top medical professionals and companies shaping the future in the fields of Anesthesiology, Ultrasound, MSK, and Pain Medicine. 50- to 100-mm, 21- to 22-gauge, short-bevel, insulated stimulating needle. NYSORA is a website that provides world-class medical education for anesthesiologists, CRNAs, pain specialists and other health professionals. Intra-articular injections are performed based on landmarks or using fluoroscopy, CT, and ultrasound imaging 28. New Addition IPACK BLOCK In NYSORA we continue working to create new educational content that combines the latest evidence-based information with requests from NYSORA readers. NYSORA is a world-renowned educational organization with a focus on regional anesthesia, ultrasound, MSK, and pain medicine. Everything you need to teach and learn about Nerve Blocks. Although most common reasons are inability to feel breathing as the abdominal and thoracic segments are anesthetized (including the stretch receptors), practitioners must rule out an impending high spinal. 1) 3. Supraclavicular Brachial Plexus Block Landmarks and Nerve Stimulator Technique. There are several scanning steps to obtain adequate nerve imaging, including the selection of sonographic modes. Twenty-first century innovations and trends have revolutionized eye surgery. Pectoralis nerve (Pecs) and serratus plane nerve blocks are newer ultrasound (US)-guided regional anesthesia techniques of the thorax. STB has approximately equal analgesic potency and distribution as ISB, with the advantage of greater sparing of the phrenic nerve. Im et al reported 96 accuracy with US guidance vs. Identify the rectus abdominis muscle and posterior rectus sheath. NYSORA Tips. Insert the needle in-plane from the medial (or lateral) side, toward the space between the popliteal artery and femur. NYSORA - Education is a YouTube channel that offers clinical and educational videos on regional anesthesia techniques, such as nerve blocks, spinal anesthesia, epidural, and more. Zoran Hadzic, a leading expert in regional anesthesia and pain medicine. They run bilaterally from the skull to the pelvis and sacral region, and from the spinous to the transverse processes, extending to the ribs. Cervical Zygapophyseal (Facet) Intra-Articular Injection 3. A plane (arrow) is developed deep to the muscle by injecting ropivacaine c. Inject 1-2 mL of local anesthetic to confirm correct needle position. Ultrasound-Guided Transversus Abdominis Plane and Quadratus Lumborum Nerve Blocks. Cervical Zygapophyseal (Facet) Intra-Articular Injection 3. Standard block tray. With the scanning procedure described above, the image required for iPACK can be developed with patient in supine (knee flexed or extended) or lateral. Ultrasound-Guided Third Occipital Nerve and Cervical Medial Branch Nerve Blocks. GON blocks are effective not only in the treatment of occipital neuralgia, which is a relatively rare pathology, but. Sheraton Hotel, Weehawken, NJ. Since the original publication on the quadratus lumborum (QL) block, the technique has evolved significantly during the last decade. Cervical Nerve Root Block. Inject 0. The nerve blocks also represent a reasonable alternative for supplementation when proximal brachial plexus block is incomplete. The one-year program aims to produce clinical and practice leaders with in-depth regional anesthesia and acute pain management knowledge. It is an acute condition of the limbs in which the pressure of isolated or groups of poorly compliant muscle compartments increases dramatically and limits local soft tissue perfusion to the point of motor and sensory impairment and neuronal and tissue ischemic necrosis. The management of PDPH after cervical ESI begins conservatively with increased hydration; use of caffeine, 50100 mg per dose, up to 250500 mg per day; supine or prone rest as tolerated; and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for headaches. With the introduction of propofol, intravenous techniques are. In 172 women undergoing minor gynecologic surgery using caudal anesthesia with 20 mL of 1. NYSORA invites you to the immersive, industry-leading education and networking experience in the world of anesthesia. Loss of continuity of axons with Wallerian degeneration due to disruption of axoplasmic flow. The nerve block should result in block of the femoral nerve in all instances (100) and the lateral femoral nerve in most instances (80100). com Phone 1 212 658 0056. AccessAnesthesiology is a subscription-based resource from McGraw Hill that features trusted medical content from the best minds in medicine. The Anesthesia Summit brings together top medical professionals and companies shaping the future in the fields of Anesthesiology, Ultrasound, MSK, and Pain Medicine. However, imaging should not be delayed to arrange MRI or to obtain neurologic consultation. NYSORAs fabled CME programs are designed to capture delegates peak attention. 77 accuracy with blind injections 6. Regional Anesthesia Tehniques. Experience the Regional Anesthesia Manual e-Course on the NYSORA LMS, and youll never go back to your old books. The systematic scanning technique described below is only theoretical, considering the fact that the examination of the ankle is, for the most, focused to one (or a few) aspect(s) only of the joint based on clinical findings. , surgery, fractures, chronic pain). Continuous peripheral nerve block equipment typically includes the following An insulated, large-bore needle (ie, Tuohy tip) with an integrated wire to allow nerve stimulation. Ultrasound-Guided Infraclavicular Brachial Plexus Nerve Block. NYSORA Tips Severe methemoglobinemia is a medical emergency requiring prompt recognition and appropriate treatment. NYSORA Tips Because these are superficial blocks of the distal peripheral nerves, some practitioners choose to use a small-gauge (eg, 25-gauge) needle. 25 bupivacaine. A 20-mL syringe containing local anesthetic. Read this chapter of NYSORA Textbook of Regional Anesthesia and Acute Pain Management online now, exclusively on AccessAnesthesiology. If aspiration is negative, slowly inject one-third to one-half (0. Ultrasound application allows for noninvasive visualization of tissue structures. Diagnosis of MS oligoclonal is made based immunoglobulin on clinical features irregularities in in combination with and its anesthetic considerations to improve care and of potentials, cerebrospinal perioperative outcomes. Real-time updates. Anatomically, a peripheral nerve is always located in the vicinity of an artery between fascial layers. This leaves plenty of time for networking, surfing, basking in the sun, golfing, or sightseeing. For interventional pain procedures, this radiation-free, point-of-care technology will also find its unique role and utility in pain medicine and can complement some of the imaging demands not met by fluoroscopy, computed tomography, and magnetic resonance imaging. Heres the definitive guide to mastering ultrasound-guided peripheral nerve. NYSORAs is. Cervical Zygapophyseal (Facet) Intra-Articular Injection 3. com Events. The Anesthesia Summit brings together top medical professionals and companies shaping the future in the fields of Anesthesiology, Ultrasound, MSK, and Pain Medicine. Consider using lidocaine or chloroprocaine for skin and subcutaneous infiltration to reduce the total dose of the more toxic long- acting local anesthetic. Third Occipital Nerve and Cervical Medial Branch Nerve Block 2. 1820G, 3. Based on the worlds leading authority on ultrasound, Dr. Continuous peripheral nerve block (CPNB) catheters, also known as perineural catheters, extend the potential duration of anesthesia and analgesia provided by peripheral nerve block techniques. Samer Narouzes book Atlas of Ultrasound-Guided Procedures in Interventional Pain Management NYSORAs Ultrasound-Guided Pain Blocks App describes the most practical and applicable. Val-d&39;Isre, France. NYSORA Tips. Regional anesthesia (RA) and. Following the ultrasound-guided intercostal nerve block, the patient experienced significant pain relief within 30 minutes. ) NYSORA Tips. It is an acute condition of the limbs in which the pressure of isolated or groups of poorly compliant muscle compartments increases dramatically and limits local soft tissue perfusion to the point of motor and sensory impairment and neuronal and tissue ischemic necrosis. Trauma accounts for 30 of all life years lost in the United States more than cancer, heart disease, and HIV combined. This schedule leaves ample time for networking, empowering connections, surfing, golfing, or exploring breathtaking sights that leave an indelible mark on the senses. NYSORAs fabled functional regional anatomy illustrations and animations. The INR should be normal 5 days after warfarin is stopped before a neuraxial procedure. Laparoscopic surgery. Access on any device. Please wait. Local and regional anesthetic techniques has largely replaced general anesthesia. Experience the Regional Anesthesia Manual e-Course on the NYSORA LMS, and youll never go back to your old books. Contact General customerservicenysora. Third Occipital Nerve and Cervical Medial Branch Nerve Block 2. In the patients with scoliosis, the vertebral body rotates toward the convex side of the curve. The superoposterior joint surface lacks a joint capsule and. , led by innovator. A flexible, atraumatic catheter that is threaded through the needle into a perineural location. com Phone 1 212 658 0056. NYSORA - Education is a YouTube channel that offers clinical and educational videos on regional anesthesia techniques, such as nerve blocks, spinal anesthesia, epidural, and more. Cervical Nerve Root Block. Apnea associated with a high spinal anesthetic is most often related to hypotension and hypoperfusion of the brainstem, rather than motor block of the nerve roots supplying the phrenic nerve (C35). Laparoscopic surgery. The latest estimates of PNB-related temporary nerve symptoms suggest an incidence of 02. Inject 0. READ MORE about Anticoagulants at this link on NYSORA Neuraxial Anesthesia and Peripheral Nerve Blocks in Patients on Anticoagulants. The effects are of variable severity depending on the maximum level that is involved but can include cardiovascular andor respiratory. Ideally, the injectate is visualized distending the. NYSORA Tips. GON blocks are effective not only in the treatment of occipital neuralgia, which is a relatively rare pathology, but. 6 Reassuringly, this rarely results in permanent injury with the incidence significantly reducing over time. NYSORA&x27;s fabled functional regional anatomy illustrations and animations. Ultrasound-Guided Supraclavicular Brachial Plexus Block Video. Real-time ultrasound images are integrated images resulting from reflection of organ surfaces and scattering within heterogeneous tissues. Obtener ideas de diseo. Access a comprehensive library of ultrasound-guided techniques, step-by-step instructions, and cognitive aids in multiple languages. 12 - 16 February. Step-by-step technique instructions. Moreover, the introduction of ultrasound in the practice of regional anesthesia has further clarified the relationship of the needle and the nerve and the dynamics of. ULTRASOUND-GUIDED CAUDAL INJECTION IS AS EFFECTIVE AS THE FLUOROSCOPY-GUIDED TECHNIQUE. Studies have shown it to be more effective that intra-articular local. Slow, continuous pressure on the 5-mL syringe containing local anesthesia will result in a hissing sound as. Ultrasound waves are characterized by a specific frequency (f) and wave length (), as described by the equation v f , where v is the speed at which the wave travels (all machines assume that US waves travel through soft tissue at 1540 ms). Transversus abdominis plane (TAP) blocks are important analgesic interventions that provide significant somatic pain relief to the abdomen. (A) Cross-sectional anatomy of the saphenous nerve at the level of the thigh. NYSORA - Education is a YouTube channel that offers clinical and educational videos on regional anesthesia techniques, such as nerve blocks, spinal anesthesia, epidural, and more. The transversus abdominis plane (TAP) block is used to produce a dermatomal sensory block of the lower thoracic and upper lumbar afferents. A sound knowledge of applied anatomy is the cornerstone of safe and effective regional anaesthesia. Much research on functional regional anesthesia, a term introduced by Dr. The equipment recommended for an obturator nerve block includes the following Ultrasound machine with linear (or curved) transducer (513 MHz), sterile sleeve, and gel. Ideally, the injectate is visualized distending the. Ideal for both learning and teaching, this app offers standardized lessons, regular. NYSORA TIPS. Ultrasound-Guided Regional Anesthesia Boutique Workshop (Tampa, FL) (2024) View Detail. campers for sale billings mt, black hole ice shack
It is a great alternative to general anesthesia in patients with multiple co-morbidities. . Nysora
Paravertebral blocks have superseded thoracic epidurals when it comes to choice of a regional anaesthesia technique to provide analgesia for breast surgery. NYSORA Tips. Access on any device; Real-time updates; All regional. ULTRASOUND-GUIDED TECHNIQUE FOR CERVICAL SELECTIVE NERVE ROOT BLOCK. With the Regional Anesthesia Manual e-Course, not only do we incorporate necessary visuals, and videos, but we also offer real-time updates making obsolete information a thing of the past. (Reproduced with permission from Hadzic A Hadzics Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, 2nd ed. Read this chapter of NYSORA Textbook of Regional Anesthesia and Acute Pain Management online now, exclusively on AccessAnesthesiology. Akkaya and coworkers 14 compared the results of ultrasound- and fluoroscopy-guided caudal epidural steroid injections in 30 postlaminectomy patients who were randomly divided into two groups. Cervical Zygapophyseal (Facet) Intra-Articular Injection 3. As part of our Nerve. Clonidine added to the axillary brachial plexus block delayed the onset of pain twofold, without adverse effects when compared with systemic control. Since the original publication on the quadratus lumborum (QL) block, the technique has evolved significantly during the last decade. In the ambulatory setting, the use of CPNB has been shown to increase the quality of pain control experienced by patients at home and to reduce the. GON blocks are effective not only in the treatment of occipital neuralgia, which is a relatively rare pathology, but. Experience the Regional Anesthesia Manual e-Course on the NYSORA LMS, and youll never go back to your old books. Trace the supraclavicular brachial plexus to the level of the interscalene space. NYSORA Tips Severe methemoglobinemia is a medical emergency requiring prompt recognition and appropriate treatment. Here are 4 steps to successfully perform a rectus sheath block Place the transducer in a transverse orientation above the umbilicus, 1 cm lateral to the midline. STEP-BY-STEP APPROACH. The volar compartment (flexor compartment) contains eight muscles the flexor pollicis longus, the. It bears the characteristics of a synovial joint, especially in the superoanterior and inferior aspects. Cervical Zygapophyseal (Facet) Intra-Articular Injection 3. Si quiere usar el Diseador, seleccione Activar. Registration includes complimentary 12-month access to the NYSORA REGIONAL ANESTHESIA MANUAL e-COURSE (formerly Compendium of RA) worth 99. Logical step-by-step. Functional Anatomy. Endoneurium, perineurium, and epineurium remain intact. Femoral Nerve Block Landmarks and Nerve Stimulator Technique. It bears the characteristics of a synovial joint, especially in the superoanterior and inferior aspects. Older patients have a reduction in pain tolerance. A rule of thumb is that the internal oblique muscle is always the thickest layer, and the transversus abdominis is. Regional Anesthesia Infographics (Flash Cards) FREE. Compre reported a single infection in 400 continuous popliteal sciatic nerve blocks (0. NYSORA Tips. 5 cc of contrast media to detect possible intravascular spread for diagnostic procedure. NYSORA&x27;s fabled functional regional anatomy illustrations and animations. Read this chapter of NYSORA Textbook of Regional Anesthesia and Acute Pain Management online now, exclusively on AccessAnesthesiology. 90 of cases occur due to a new mutation during early development, while 10 are inherited (autosomal dominant). The top team of instructors teaches from NYSORAs GOLD-standard, practical, and comprehensive COMPENDIUM of Regional Anesthesia and Acute Pain. 90 of cases occur due to a new mutation during early development, while 10 are inherited (autosomal dominant). We wanted to share these 4 tips to perform an interscalene brachial plexus block successfully. When required, this nerve should be blocked as described in Ultrasound-Guided Obturator Nerve block. Severe sepsis accounts for 2. NYSORA is a website that provides world-class medical education for anesthesiologists, CRNAs, pain specialists and other health professionals. Transforaminal epidural steroid injections (TFESI), also known as transforaminal nerve root injections or nerve root blocks, are performed for the treatment and. For deeper nerves, a 9-MHz transducer can be used. An equipment cart should contain all of the drugs, needles, and catheters necessary for regional anesthesia as well as resuscitation medications and equipment. Unfortunately, higher frequency waves are attenuated more than lower frequency waves. In this video we discuss the ultrasound guided popliteal sciatic nerve block, including anatomy, sonoanatomy, indiations, and tips for success. These structures include the pancreas, liver, gallbladder. Anatomic variations of the sacrum and the contents within the sacral canal pose a challenge during caudal epidural steroid injections. 2 deletion syndrome, is a syndrome caused by a heterozygous microdeletion on the long arm of chromosome 22. NYSORA Tips Obstetric patients often complain of difficulty breathing during cesarean section delivery under neuraxial anesthesia. 8 at 6 months. Ultrasound-guided transversus abdominis plane (TAP) and quadratus lumborum (QL) blocks have become a common analgesic method after surgery involving the abdominal wall. Find out the landmarks, nerve stimulator technique, and indications for each block. NYSORA Tips. Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches (PDPHs). NYSORA - Education is a YouTube channel that offers clinical and educational videos on regional anesthesia techniques, such as nerve blocks, spinal anesthesia, epidural, and more. Here at NYSORA, we follow these scanning tips when performing the Thoracic Paravertebral Block Place the transducer lateral to the spinous process with the orientation marker directed to the patients right side and identify the following structures on a transverse scan of the thoracic paravertebral region Paraspinal muscles Clearly. The NYSORA Regional Anesthesiology and Acute Pain Medicine Fellowship in Belgium is one of the best known training programs in the world. Local twitches of the quadriceps muscle are often elicited during needle advancement. 1. The Anesthesia Summit brings together top medical professionals and companies shaping the future in the fields of Anesthesiology, Ultrasound, MSK, and Pain Medicine. Neck Surgery. NYSORA - Education is a YouTube channel that offers clinical and educational videos on regional anesthesia techniques, such as nerve blocks, spinal anesthesia, epidural, and more. Experience the unrivaled allure of NYSORAs CME programs, meticulously designed to captivate delegates peak attention from 8 am to 10 am and 5 pm to 7 pm. With the Regional Anesthesia Manual e-Course, not only do we incorporate necessary visuals, and videos, but we also offer real-time updates making obsolete information a thing of the past. Suprainguinal fascia iliaca injection site for a patients hip from a sagittal view. The transducer is then rotated to obtain the short-axis view of the desired level. CT or CT myelography is acceptable as initial imaging to exclude a compressive lesion. An equipment cart should contain all of the drugs, needles, and catheters necessary for regional anesthesia as well as resuscitation medications and equipment. The techniques vary in the transducer orientation, needle insertion and recommended volumes of local anesthetic. This chapter aims to discuss the role of regional anesthesia within. Place the transducer over the anterior superior iliac spine (ASIS) initially, with the. Third Occipital Nerve and Cervical Medial Branch Nerve Block 2. For more tips. An ultrasound (US)-guided technique was first introduced by our group in 2010 1. NYSORA Tips. NYSORA Tips. STEP-BY-STEP APPROACH. There is a decreased incidence and severity of hemidiaphragmatic paresis with a low-dose block, compared with the more commonly used dose of 20 mL of the same local anesthetic solution 12. Overall, mortality reaches 28 (). Cervical Nerve Root Block. Insert the needle in-plane through the rectus abdominis muscle until the tip reaches the space between the muscle and. 5 in. - Most clinically applicable excerpts from NYSORA&x27;s best selling textbooks. Third Occipital Nerve and Cervical Medial Branch Nerve Block 2. Nov 24, 2022 The lateral femoral cutaneous nerve (LFCN) innervates the skin of the anterior and lateral parts of the thigh as far as the knee. Pectoralis nerve (Pecs) and serratus plane nerve blocks are newer ultrasound (US)-guided regional anesthesia techniques of the thorax. Typically, 20 mL (range of 15 -25 mL) of local solution is infiltrated in the tissue plane. Regional and Topical Anesthesia for Awake Endotracheal Intubation. Epinephrine is frequently added to LA solutions to cause vasoconstriction and to serve as a marker for intravascular injection. . motorway speed camera flashed twice