Caution/Triage/Accessory Techniques Flashcards
What’s the most common adverse event with acupuncture?
bleeding/bruising
Caution for needling which acupuncture points due to proximity to large blood vessels?
ST9, ST12, ST13, ST42, HT1, HT7, LU9, LV12, UB40, SP11
What can you do to decrease risk of fainting?
1) have patient eat 1-2 hours beforehand
2) explain everything before needling (first time)
3) position pt supine with legs elevated
4) limit needle manipulation initially
What can be done to remove a stuck needle?
1) rotate in opposite direction of insertion
2) stimulate nearby area with finger manipulation/tapping or by inserting another needle nearby
3) wait then try again
What are the symptoms of iatrogenic pneumothorax with acupuncture (2/250,000)?
immediate or delayed: dyspnea on exertion, tachycardia, chest pain, dry cough, cyanosis, diaphoresis/sweating
Who is at increased risk for an iatrogenic pneumothorax?
thinner patients, smokers (cigarette/marijuana), lung disease patients (asthma, emphysema, COPD, lung cancer, steroids), Marfan syndrome, homocysteinuria, thoracic endometriosis
Which points require caution d/t risk of pneumothorax?
GB21, UB13, ST12, CV22
Also UB18, CV14, CV15, SI9, SI13, Ding chuan
What can cause injury to the heart during needling?
1) sternal foramen (4th ICS level)
2) upward angle at CV15
3) excessive needle length/insertion
What’s the safe insertion depth to avoid heart injury?
25 mm
To avoid lung injury, what’s the safe insertion depth for acupuncture points over the lung fields?
10-20 mm
What are the S/S of cardiac tamponade?
anxiety, restlessness,
low blood pressure, weakness,
chest pain radiating to neck/shoulder/back/abdomen,
chest pain that gets worse w/deep breathing or coughing, problems breathing or rapid breathing,
discomfort alleviated by sitting or leaning forward,
fainting or light headedness,
palpitations,
drowsiness,
weak or absent peripheral pulses
Who is at higher risk for cardiac tamponade?
patients with cardiomegaly (from CHF, chronic HTN)
Who is at higher risk for liver organ damage w/acupuncture?
patients with hepatomegaly (from alcoholism, hepatitis, hepatocellular carcinoma, infectious mono, Reye’s syndrome, biliary cirrhosis, sarcoidosis, steatosis…
Who is at higher risk for spleen organ damage w/acupuncture?
patients with splenomegaly from infections (mono), AIDS, malaria, anaplasmosis, cancers, sickle cell dz, thalassemia, spherocytosis
What are the S/S of abdominal organ puncture?
abdominal pain, rigidity of abdominal muscles,
rebound pain upon pressure
lumbar pain & positive Murphy’s sign, bloody urine
What is the distance from the skin surface to the spinal cord or roots of spinal nerves?
25-45 mm depending on patient constitution
Most acupuncture related infections were from which bacterium?
mycobacterium
What can cause a broken needle situation?
1) Manufacturer defects or poor needle quality
2) patient change in position
3) strong muscle spasm
4) excessive force in needle manipulation
5) needle struck by external force
6) rigid withdrawal of bent needle
What do you do in a broken needle situation?
Remain calm & advise patient not to move
If needle is above skin, remove w/forceps
If needle level w/skin, press tissues around site gently until needle exposed for forceps removal
If needle completely under skin, seek medical attention immediately (remove all other needles & call for emergency transport)
What types of conditions is moxa effective for?
musculoskeletal, GI, gynecologic, breech presentation, stroke rehab, cancer symptoms, infectious diseases
Which body regions are off limits for moxa?
face/head, within hairline, nipples, genitals
If moxa results in a burn, what do you do?
If small 1st degree burn: run cool water over the burn & then apply sterile gauze secured to the skin w/medical tape; may use OTC burn creams
If severe burn or concern w/infection, refer to a physician
If more than 1 cm of skin is burned, assess skin damage & consider referral
What are the 3 kinds of cupping?
Fire (dry), Suction (dry), Wet
What is cupping used to treat?
Pain, colds, flu, fever, respiratory problems (asthma, bronchitis, emphysema, functional & internal organ problems, musculoskeletal problems, persistent/recurring fixed pain
What’s the time limit for Fire cupping?
2-10 min
What’s the time limit for suction cupping?
2-10-20 min
What’s the risk with Wet cupping?
blood-borne infection risk
What’s the risk with needle cupping?
organ puncture or CNS damage if needle goes deeper
Who is at higher risk for cupping?
patients with keloid scars,
psoriasis patients (Koebner phenomenon),
IDA (NO wet cupping!)
acquired hemophilia
patients w/bleeding disorders (Von Willebrand’s dz, hemophilia) or on blood thinners (meds or supplements)
vasovagal syncope (DM, renal dz, seizure disorders, fasting/low blood sugar)
What should be done if a suction bulla occurs?
instruct patient to use antibiotic topical ointment & keep the area clean & covered unit healed
What is panniculitis and how long does it take to heal?
inflammation of the fatty layer; fades like a deep bruise in 6 weeks; usually self-limiting but can become infected and require surgery
If patient develops subcutaneous nodules, avoid further cupping & refer for medical observation
What percent alcohol should be used to clean skin?
60-70%
What’s the rule for cupping and gua sha relative to chemotherapy?
No cupping or gua sha for 48 hours before or 24 hours after chemotherapy treatment
What is electroacupuncture used for?
conditions associated w/Qi, Xue or Phlegm stagnation
chronic pain syndromes
What’s the therapeutic EA current?
0.5-6 mA
Which patients cannot have EA done?
NO EA on trunk of patients w/implanted medical devices (defibrillator, etc.), pacemakers, etc.
If patient has HX of seizure disorder, consult w/PCP before doing EA
NO EA on infants, children, incapacitated, sleeping/unconscious patients
Which anatomical regions are off limits for EA?
anterior triangle of neck
posterior cervical area (brainstem)
crossing the spine
crossing the heart/chest (front to back OR side to side)
What does gua sha treat?
pain, blanching that’s slow to fade, acute respiratory infection, influenza, fever, internal organ dz where ferroheme metabolism can reduce inflammation & offer immune protection
in trials: effective for neck pain, back pain, breast engorgement/mastitis
How does gua sha work?
increases surface micro perfusion & up regulates heme oxygenate through ferroheme metabolism
How long for post-Gua sha petechiae & ecchymosis to resolve?
2-4 days
Is gua sha contraindicated for patients on anti-coagulant meds?
Not if they have a stable INR
What is plum blossom needling used to treat?
pain syndromes, including neuropathies
How long are press tacks and intradermal needles left in place?
for 1 to several days (removed by practitioner)
What does Tai Na treat?
variety of pain & musculoskeletal syndromes
What are the contraindications for Tui Na?
wounds, dermatoses, diseases w/hemorrhagic tendencies, acute infectious dzs, dzs of brain/heart/liver/kidney/other viscera, menstruation & pregnancy
How do you needle DU15?
perpendicular 0.5-0.8 cun (or will damage medulla oblongata if go too deep)
Avoid which points if metopism (open fontanelle)?
DU22, DU23, DU24
What is the guideline for needling over the chest area?
Oblique 0.3-0.5 cun
At what acupuncture point is the heart apex?
KD22 (5th ICS)
At what acupuncture point is the liver apex?
KD21
What class disinfectant is chlorine?
low-level for non-critical items
What class disinfectant is gluteraldehyde?
high-level for critical items
What class disinfectant is hydrogen peroxide (6-25%)?
high-level
What class disinfectants are iodophors and phenol?
low level
Which forms of hepatitis are transmitted fecal-oral route?
Hep A & Hep E
Which forms of hepatitis are transmitted by blood or sex?
Hep B, C, D
Which forms of hepatitis have acute onset symptoms?
Hep A & E (rest are insidious)
What is the incubation period for Hep A?
15-50 days (ave 28)
What is a nosocomial infection?
an infection acquired in a healthcare setting
How long can Hep A survive in the environment?
for months (killed by heating to > 185 degrees for one minute and by water chlorination)
What is the incubation period for Hep B?
45-160 days
How long can Hep B survive in environment?
7 days
What is the incubation period for Hep C?
14-180 days
How long can Hep C survive in environment?
4-5 days
What is the incubation period for Hep E?
15-60 days
How long can HIV survive in the environment?
minutes
How long can TB survive in the environment?
4 weeks - 74 days
How long can MRSA survive in the environment?
up to 90 days on dry surfaces
How long can influenza survive in the environment?
up to 24 hours
Which Hepatitis virus has the longest incubation period?
C
Which Hepatitis virus has the shortest incubation period?
A
What is the incubation period for TB?
12 weeks
