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35 Cards in this Set

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  • Back
Local anesthesia can be used in what procedures
repair lacerations
skin surgery
treatment of painful oral or genital lesions
removal of superficial lesions
local anesthesia blocks nerve impulses by
selectively binding volatage gated Na channels
two parts of an anesthetic and what they do
hydrophylic - allows to be injectedin solution. Binds to sodium channels
hydrophobic - enter the neuronal membrane
Nerve impulses are lost in what order
temp, pain, touch, deep pressure, motor
Variables that effect quality of local anesthesia
Rate of conduction
Presence of myelin
Nerve fiber diameter
Vascularity of the location
Ester anasthetics
benzocaine, cocaine, procaine, and tetracaine
Amide anesthetics
lidocaine, mepivacaine, bupivacaine, dibucaine, and prilocaine
Epinephrine is more effective with which anesthetics
less lipid soluble
ie: lidocaine and mepivacaine
why do anesthetics hurt when they are injected and how can this be avoided?
the solutions are acidic but equilibrate to body pH on injection. Pain can be avoided by buffering the solution with sodium bicarb, however, this reduces the shelf life
technique for painless injection
inject at level of dermis and subQ fat
which type of anesthetic is metabolized fastest
ester
Bupivicaine causes side effects in pt's with what and why
severe liver disease
it is highly bound to plasma protiens made in the liver
Cocaine containing products should be avoided in:
infants and neonates
fingers, nose, penis, toes, pinna of the ear
Non cocaine containing have a few contraindications in:
premature infants
Contraindications for use of local anesthesia
severly unstable blood pressure
true allergy
severe liver disease and amides
severe renal disease and esters
Absolute Contraindications for epinephrine use
untreated hyperthyroid or pheochromocytoma
body parts with single blood supply
relative contraindications for epinephrine
untreated HTN
severe CAD or PVD
Pregnancy
Narrow angle glaucoma
Pts using: beta blockers, phenothiazines, MAOIs, or tricyclic antidepressants
most common complication with local anesthesia (LA)
anxiety over impending injection leading to vasovagal reaction
Other local complications of LA
Bruising
Edema
Infection
Nerve damage
temporary motor n. paralysis
Systemic complications of LA
Hypotension
Bradycardia
CNS depression or stimulation
Systemic complications of epinephrine
Cardiac dysrythmias
HTN
Anxiety
Cardiac arrest
Cerebral hemorrhage
Ischemia
True allergy is characterized by:
skin rash
localized or general urticaria, angioedema
anaphylaxis with hypotension
Pt prep
Reassure
Pt supine and cannot see injection
Conversation
Inform
Pt take deep slow breaths
Topical anesthesia can be used for
Highly vascular like face and scalp
Wound closure if 5cm or less
Most commonly used injectable anesthesia
Lidocaine
Mepivacine
Bupivacaine
Diphenhydramine if allergic
*Onset of action lengthens L,M,B
*Duration of action lengthens L,M, B
Procedure for topical
Use EMLA or ELA-Max
Do not touch mucous membranes
Remove blood clots from area
Saturate gauze
Fold into and around wound, tape in place
Apply pressure 15-20 min (no more than 2 hrs)Wear gloves in order to avoid absorption.
Anesthesia complete when blanching occurrs.
Remove before start of procedure
Needle for injection of anesthesia
27 or 30G
1/2 to 1 1/4 inch
1 to 3mL syringe
Direct wound infiltration for:
minimally contaminated wounds
How do you make sure the needle is not in a vessel
Aspirate looking for blood
Procedure direct infiltration of wound
B/G injection on side where sensory inn. originates, and pocede distally
Insiert at dermis and sub Q fat
Aspirate
inject small amount
reposition adjacent to but within injection area, aspirate, repeat until all edges are anesthetized
Procedure for intact skin
Clean site
Pinch skin
Initiate at dermis and subQ fat
Repostition to epidermis and inject
Procedure for field block
Use large bore long needle
Insert to hub parallel to dermis and subQ fat
Aspirate
Slow inject as needle withdrawn
Reinsert at end of first track repeat until wall surrrounds area
Procedure digital block
inject distal to web space in middle of digit
aspirate, inject 1mL into epidermis
advance to bone
withdraw slightly then move dorsal, aspirate, inject .5mL
withdraw needle to midline, advance to bone, move ventral, inject .5-1mL
Repeat on other side of digit
Digital lock recommended for
nail avulsion, paronchyial drainage, repair of lacerations to the digit
Follow up care and instruction LA
notify office if:
unusual skin color, itching, pain or if sensation does not return after alotted time.