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48 Cards in this Set
- Front
- Back
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What is the order of sensory nerve impulse loss when using local anesthetics?
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1.) Temperature sensation
2.) Pain 3.) Touch 4.) Deep pressure 5.) Motor |
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What factors affect local anesthesia? (8)
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Rate of Conduction
Presence of Myelin Nerve Fiber Diameter Use of Epinephrine Anesthetic Solution & Tissue pH Method and Technique of Injection Concentration of Solution Total Dose Provided Rate of Metabolism |
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Which local anesthetic is contraindicated for use with infants?
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Cocaine
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The use of topical anesthetics (EMLA) in infants may cause __________
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methemoglobinemia
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What are the potential local complications associated with local anesthesia?
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Bruising, edema, infection
Prolonged or permanent nerve damage Temporary motor nerve paralysis |
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What are the systemic complications associated with local anesthesia (usually from IV or arterial admin) ?
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Decreased B/P & HR
CNS depression: Slurred speech, drowsiness, tremor, weakness, paralysis, respiratory failure, coma, seizures, etc. |
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What are the most common complications associated with local anesthetic?
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Anxiety and vasovagal rxn (decreased B/P, HR, and syncope)
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Which anesthetic is most likely to cause a systemic complication?
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Bupivacaine (Marcaine)
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What are the complications associated with using Epinepherine as a local anesthetic?
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Cardiac dysrhythmias
Hypertension Anxiety Cardiac arrest Cerebral hemorrhage Ischemia |
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What is the maximum amount of time that EMLA should be in contact with the skin?
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2 hrs
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Can you use EMLA on mucus membranes?
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NO
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If you have a 3-4 inch laceration how much anesthetic should be used?
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3-5 ml
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What are the indications for a digital block?
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Procedures distal to mid-proximal phalanx
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Which anesthetics should be used for a digital block?
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Lidocaine or Mepivacaine – fast onset
Lidocaine and Marcaine – fast onset and long duration |
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Where do you inject for a digital block?
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Distal to webspace
or At one side along lateral or medial side of digit |
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Which local anesthetic has the longest anesthetic and analgesic properties?
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Bupivacaine
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How soon must a pt be seen in the ED following a laceration if they are going to need stitches?
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8 hrs
24 hrs if the area has an excellent blood supply & cosmesis is important |
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What are the complications associated with wound closure?
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Infection
Scarring (keloid) Loss of function and/or structure Loss of cosmesis Dehiscence Tetanus |
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What are Langer's Lines?
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Clefts in skin that indicate the orientation of collagen fibers
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What is a clean-contaminated wound?
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Occurred in a clean environment (surgery etc), but contaminated with GI, GU, or respiratory secretions
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What is a primary intention wound closure?
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All Layers Closed
Minimal scarring Clean or clean-contaminated wounds |
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What is a secondary intention wound closure?
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Deep layers closed and superficial layer allowed to granulate
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What is an infected wound?
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Established infection before wound is made (abscess)
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What is a third intention wound closure?
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Deep layer closed, superficial layers left open until reassessment on 4-5th day then inspected for infection
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What is the order of treatment for an open wound?
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Irrigation
Cleansing Suturing Bandage Tetanus status |
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What are the tools needed for irrigation of an open wound?
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60 ml syringe
Intracath Saline Pulsatile Vacuum (Pulsavac) |
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What instruments are needed for wound debridement?
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Scalpel
Forceps Scissors |
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What are the contraindications to cryosurgery?
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Cryoglobulinemia
Cold intolerance (Raynaud, cold urticaria) Lesions over nerves Dark-skin patients (hypopigmentation) |
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Continuous freezing, longer than 30 seconds can result in _____________
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disruption of the collagen matrix of the skin and possible scarring
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What are the indications for cryotherapy of skin lesions?
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Warts
Moles Skin tags Solar keratosis Small skin cancers |
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What internal disorders can be treated with cryotherapy?
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Prostate cancer
Cervical dysplasia Liver cancer Hemorrhoids |
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What are the conservative treatments that can be used for ingrown toenails?
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Elevation of nail plate with small cotton ball
Frequent soaking Loose fitting shoes Selective trimming |
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What are the contraindications for an ingrown toenail removal?
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Bleeding diathesis
Allergy to local anesthetic |
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What are the complications associated with ingrown toenail treatment?
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Infection
Regrowth if nailbed is not ablated Distal toe ischemia (tourniquet) Damage to underlying tissue with excessive electrocautery Nailbed laceration Patients response to result (narrow nail) |
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What are the follow up instructions that should be given to a pt following subungual hemorrhage treatment?
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Soak digit in warm soapy water 2-3 X daily
Keep light dressing over area until closed completely Call if pain persist, numbness results, signs of infection Discomfort should improve progressively in a few days |
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What materials are needed for an anoscopy exam?
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Anoscope with obturator
Water soluble lubricant Gloves Light source Culture swabs (when appropriate) Monsel’s Solution Large cotton tip swabs |
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What are the contraindications for an anoscopy exam?
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Severe rectal pain
Perirectal abscess Acutely thrombosed hemorrhoids Acute anal fissure Severe anal stricture |
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What are the potential complications associated with an anoscopy exam?
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Anal or perirectal tears (usually mild)
Bleeding |
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Internal hemorrhoids arise ________ the dentate line
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above
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External hemorrhoids arise _______ the dentate line
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below
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Which patients should have an annual sigmoidoscopy?
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Family H/O familial polyposis or 1st degree relative with H/O CoCa
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What are the contraindications to a flex-sig?
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Fulminant colitis
Severe or acute diverticulitis Toxic megacolon Acute peritonitis Poor bowel preparation Poor patient cooperation Severe cardiopulmonary disease |
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What are the potential complications associated with a flex-sig?
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Spotting and minor bleeding
Bowel perforation (most serious complication) Tears at anastomosis sites Electrocautery-induced explosion |
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How do you know you have reached the entrance to the sigmoid colon when preforming a flex-sig?
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Haustra
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What is the colon prep for a flex-sig?
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Liquid diet 24 hrs prior
1-2 enemas (no harsh laxatives) |
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What should you tell pts about their medications prior to a flex-sig?
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Continue current meds
D/C ASA, NSAIDS, anticoagulants Prophylactic ABX w/ cardiac valve dz |
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What position should the pt be placed in for a flex-sig?
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Left Lateral (Sim's) Position
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What are the follow up instructions for pts following a flex-sig?
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Normal spotting or mild bleeding with cramping & bloating are possible
Return for severe abdominal pain, significant distension, N/V, fever, chills, rectal bleeding > ½ cup |
