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Pharm II > (2-15-17) Venipuncture Sedation Complications & Common Office Emergencies > Flashcards

(2-15-17) Venipuncture Sedation Complications & Common Office Emergencies Flashcards

1
Q

what is the indwelling catheter?

A

the plastic part that stays in your arm after you remove the needle

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2
Q

what does the gauge of a needle refer to?

A

the external diameter of the needle

**it is the number of needles that can be placed into a 1inch circle

*therefore the lower the gauge the larger the size of the lumen

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3
Q

what is the highest gauge needle used for?

A

acupuncture (30)

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4
Q

what gauge needle is used for local anesthesia?

A

25, 27

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5
Q

What are the 4 different types of solution for IV administration?

A
  • lactated ringers
  • sodium chloride
  • 5% dextrose in water
  • sterile water for injection
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6
Q

what are the most commonly used sizes of solution?

A

250, 500, 1000 mL

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7
Q

what things should you check before administering the solution?

A
  • is the fluid clear
  • expiration date
  • sealed?
  • any doubt about sterility
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8
Q

what is the adult infusion rate set at?

A

10 drops = 1 mL

can be adjusted if a person needs more

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9
Q

what is the pediatric infusion rate set at?

A

60 drops = 1 mL

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10
Q

when applying a touniquet, where should it go?

A

2 - 6 inches above intended site

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11
Q

when applying a touniquet, what should still be palpable after applying?

A

brachial artery

radial artery

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12
Q

when applying a touniquet, what knot should you tie it with?

A

slip knot

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13
Q

when applying a touniquet, what stimulates blood flow?

A

pumping fist

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14
Q

do you have to wear gloves when you tie a touniquet? what about when you clense the site?

A
  • tourniquet = no

- clensing = yes

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15
Q

what are the steps in placing the needle?

A
  • hold the skin taught
  • position the needle for insertion (10-30 degrees)
  • insert the needle and look for blood (stop at blood)
  • advance the needle or catheter
  • apply pressure over tip and remove needle from catheter
  • connect infusion tubing
  • secure by taping (or tegaderm)
  • immobilize the elbow
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16
Q

how should you position the needle for insertion?

A

10-30 degrees to plane

-BEVEL UP

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17
Q

what could cause slow or non running fluids?

A
  • bag too close to heart level
  • bevel of needle against wall of a valve
  • tourniquet left of the arm
  • infiltration
  • tube kink
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18
Q

what is a venospasm?

A
  • protective mechanism due to stimulation
  • the vein may disappear or collapse
  • occasionally accompained by painless sensation

*occurs more in apprehensive pts due to the high release of catecholamine

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19
Q

who does venospasms affect more?

A

occurs more in apprehensive pts due to the high release of catecholamine

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20
Q

what might help if your pt experiences a venospasm?

A

-heat (may help the vein to reappear)

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21
Q

what is a hematoma?

A
  • extravasation of blood into surrounding interstitial spaces
  • painless, bluish discoloration
  • not always preventable
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22
Q

what should you do if your pt experiences a hematoma?

A
  • remove tourniquet to dec venous pressure
  • apply ice: VC
  • subsequential management: heat can be applied no less than 4 hours
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23
Q

how is an air embolism prevented?

A
  • eliminating air bubble from the tubing
  • rule of thumb: pt can tolderate up to 1 mL/kg of air in the venous circulation without adverse affect
  • children are more significant
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24
Q

if your pt gets an air embolism, how do you manage that?

A

attempt to prevent air from entering the cerebral or pulmonary circulation by:

  • adjusting the patient/chair
  • head down and lying on the left
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25
Q

for what kinds of pts is over-hydration very significant for?

A
  • heart failure pts
  • children

*can cause pulmonary edema, respiratory distress, tachycardia, inc BP

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26
Q

what is the best way to prevent over-hydration?

A

calculate fluid deficit and how many hrs the pt NPO (?)

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27
Q

what does the extravasation of drugs cause?

A
  • pain (does not migrate up or down the arm)(localized to needle tip)
  • delayed drug absorption
  • tissue damage (diazepam and pentobartal)
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28
Q

what is the management for extravasation of drug?

A
  • remove the needle, apply pressure if less than 2mL of drug has leaked
  • if more than 2 mL of drug has leaked, 1% procaine in a fan type injection
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29
Q

what local complication of drug administration is considered an emergency?

A

intra-arterial injection

*chemical insult: spasm that will compromise distal circulation, chemical endarteritis: lead to thrombosis and ischemia

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30
Q

where is intra-arterial injection most common to happen?

A

medial aspect of the antecubital fossa where the brachial artery is superficial

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31
Q

what is the best way to recognize an intra-arterial injection?

A
  • prevention is the most important feature to avoid this
  • assess the blood color (bright cherry red = bad)
  • look for pulsatile flow in the tubing with every heart beat (arterial pressure will rise following removal of the touniquet)
  • severe pain will radiate peripherally from the site outwards to the hands or fingers (unlike extravasation)
  • absence of radial pulse
  • molted skin color
  • cool limb
  • GANGRENE
32
Q

what is the management of intra-arterial injection

A
  • leave the needle in place
  • give 1% procaine
  • hospitalize the pt (sympathetic nerve block)
  • surgical endartecomy
  • heparinization
  • amputation of the gangrenous limb if treatment failed
  • hyperbaric oxygen
33
Q

what are some local venous complications?

A
  • phlebitis: inflammation of the veins
  • thrombophelbitis: inflammation of the vein wall have preceded a thrombus formation
  • pain and tenderness
  • edema
  • delayed onset
34
Q

what are the causes for local venous complications?

A
  • pH
  • needle mechanical irritation
  • venipuncture technique (size related to lumen)
35
Q

what is the management for local venous complications?

A
  • limit limb activity (sling)
  • elevate the limb
  • moist heat for 20 min TID
  • NSAIDS
  • conditions worsen –> vascular surgery
36
Q

what are the potential causes for a pt to experience nauseau and vomitting?

A
  • swallowing blood
  • OPIODS
  • hypoxia
37
Q

what is the management of nausea alone?

A

give O2 + IV antiemetic

*Zofran

38
Q

what is the management of vomitting alone?

A
  • stop tx immediately
  • turn pt to RIGHT side
  • suction the mouth
  • IV antiemetic

*Zofran

39
Q

what is the most common cause of airway obstruction?

A
  • prolapsed tongue

* other causes: foreign bodies, debris

40
Q

what are some maneuvers to establish and maintain airways?

A
  • head tilt chin lift/jaw thrust
  • use of airway adjuncts as necessary
  • if obstruction other than tongue, identify and remove foreign objects
41
Q

what does the head tilt chin lift do?

A
  • displaces the prolased tongue from the posterior pharyngeal wall
  • eliminates obstruction
42
Q

intended as an improved alternative to the traditional face mack
-minimizes trauma

A

laryngeal mask airway

43
Q

what are the indicators to use a laryngeal mask airway?

A
  • alternative airway
  • difficult airway
  • cant ventilate
  • failed intubation
  • can’t move head or neck
  • no laryngoscope
44
Q

what are the advantages to using a laryngeal mask airway?

A
  • minimal training
  • shortest placement time
  • can use in PEDIATRIC pts
  • least amount of tissue trauma
  • can use to intubate
45
Q

is a double lumen airway that is blindly inserted that is used to ventilate pt regarless of tracheal or esophageal placement

A

combitube

46
Q

what is the most secure airway you can get?

A

tracheal intubation

47
Q

what is a laryngospasm?

A

partial or complete closure of vocal cords due to direct irritation of cords by foreign matter during light planes of anesthesia

48
Q

what unique thing occurs with laryngospasm?

A

“crowing” noise

*inc respiratory effort with difficulty exchanging air

49
Q

how would someone manage a laryngospasm?

A
  • terminate procedure: back off surgical sites
  • deliver 100% O2
  • position head
  • protrude tongue, and suction oro, nasal, and hypopharynx
  • push on chest, listen for rush of air
  • if unsuccessful, 0.5-1.0cc of Succinylcholine IV or sublingually
  • 100% positive pressure O2 by face mask, support ventilations until pt able to spontaneoulsy ventilate
  • watch for bradycardia or other rhythm disturbances
50
Q

is hypo or hyper-glycemia more dangerous?

A

HYPO

51
Q

what is the normal blood glucose level

A

70-110 mg/dl

52
Q

what occurs when the bodys blood glucose level falls to 50-70? what about 20-50?

A

50-70 = CNS becomes excitable (inc neural activity) extremenervousness, sweating and treambling

20 - 50 = convulsions, loss of consciousness, shock

53
Q

what is in our kit as dentist to raise blood sugar if it gets too low?

A

glucogon

54
Q

what is the management of a hypoglycemic pt if they are still conscious?

A

-recognition of hypoglycemia
-oral carbs
-monitor
-permit pt to recover
If no response, oral IV 50% dextrose
-get assistance

55
Q

what is the management of a hypoglycemic pt if they are unconscious?

A
  • get help
  • BLS (ABC’s) O2
  • monitor vitals
  • definitive care
  • -administer carbs
  • -50% dextrose
  • -glucagon 1mg IM
56
Q

what is an allergy?

A
  • hypersensitive state
  • acquired through exposure and then re-exposure to a particular antigen
  • results in a heightened/exaggerated response of the immune system
  • has a broad range of onset
  • –delayed 48hrs
  • –immediate
57
Q

what are the 4 commonly used drugs with allergic potential?

A
  • antibiotics
  • analgesics
  • antianxiety drugs
  • local anesthetics
58
Q

allergies affect multiple organ systems, but primarily the…

A
  • skin (most common)
  • respiratory system (after skin but before CVS)
  • CVS
  • GI tract

*if HYPOtension is involved then leads to anaphyplactic shock

59
Q

when does an allergy lead to anaphylactic shock?

A

when HYPOtension is involved

60
Q

what is the main issue of an allergy on the CVS system?

A

angioedema of the larynx

61
Q

what is the management of allergic reactions?

A

*easier to avoid than treat

  • good initial hx
  • what drug was used
  • what happend
  • –clinical manifestations, onset of symptoms, rate of pregression
  • what tx was required
62
Q

what are the symptoms of anaphylactic shock?

A
  • progressive respiratory and circulatory failure
  • itching of the nose and hands
  • flushing of the face
  • feeling of substermal pressure
  • labored breathing, stridor, coughing
  • sudden hypotension
  • cyanosis
63
Q

what is the management for a pt what goes into anaphylactic shock?

A
  • get help
  • postion pt (BLS)
  • oxygen
  • monitor pulse and vitals
  • establish IV access if necessary
  • epi 0.1mg IV
  • antihistamines and steroids
  • transfer to hospital
64
Q

what is medelson’s syndrome?

A

-vomit -> aspirate -> die

65
Q

what are the major factors to control in regards to aspiration?

A
  • amount of gastric fluid
  • pH of gastric fluid
  • presence of solid debris
66
Q

what is the management of aspiration?

A
  • observe for signs of potential emesis (swallowing, diaphoresis (sweating) , heaving)
  • position pt, suction readily available
  • seek out medial attention when aspiration strongly suspected
67
Q

what causes intrinsic asthma?

A

allergy; antigen-antibody response

68
Q

what causes extrinsic asthma?

A
  • infection
  • exercise
  • irritating inhalants
  • emotional stress
  • anxiety
69
Q

what is the managment of a pt with asthma?

A
  • position pt
  • administer bronchodilator
  • 100% O2 by face mask
  • monitor pt
  • if not resonsive, epi subcutaneously (0.3mg q30-60 min)
  • activate EMS
70
Q

what do you give for a pt with an Opiod overdose?

A
  • naloxone (Narcan)
  • supplied as 0.4mg/mL add 3 mL of saline
  • give 0.1 mg slowly as assess the response

-monitor for one hour in the office

71
Q

what do you give for a pt with benzodiasepine overdose?

A
  • flumzenil (Romazicon) 0.1 mg/mL

* give an initial dose of 0.2mg with subsequent doeses administered as needed to a max dose of 1mg

72
Q

what are the clinical manifestations of angina?

A
  • sudden onset with exertion (sub-sternal pain)
  • squeezing, choking, burning, pressing, tightness (heavy weight on chest)
  • radiation to NECK, JAWS, TEETH, SHOULDER
73
Q

what is the management of a pt with angina?

A
  • terminate procedure
  • position pt
  • supplemental O2
  • administer nitro
  • reevaluate
74
Q

what is a myocardial infarction?

A
  • deficient coronary blood supply to myocardium

* leads to cellular death and necrosis

75
Q

what are the clinical manifestations of a myocardial infection?

A
  • may occur at rest, after excercise, or emotional stress
  • sudden onset, pain is prolonged
  • described as crushing, substernal pain
  • NOT relieved by NITRO
  • nausea, vomiting, cold perspiration
  • weakness, dizziness, palpatations
76
Q

what is the management of an MI?

A
  • terminate procedure and all painful stimulation
  • initiate EMS (time is now an issue)
  • basic action plan
  • –position pt
  • –place monitors
  • –keep a record of events

MONA

77
Q

what is MONA in reference to an MI?

A
  • Morphine
  • Oxygen
  • Nitro
  • Aspirin

Pharm II (16 decks)

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