CNT + RISK MANAGEMENT Flashcards by Kathleen Cabanayan

What is the course of action if your patient is experiencing severe pain, severe injury, serious acute symptoms/ illness, medical condition that is getting worse?

Call 911

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Your patient has passed out in your waiting room. They have no sign of breathing or pulse. You begin CPR. You find out later that they suffered 3 fractured ribs from compressions. What is your liability, if any?

Practitioners are not liable because fractured ribs are an acknowledged risk of performing CPR and cannot conclusively be attributed to malpractice.

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Your patient has passed out in the waiting room. They have a faint pulse and they are barely breathing. What is your course of action?
A) Begin CPR
B) Provide ventilation sans compressions
C) Begin compressions sans ventilation

B - provide ventilation sans compressions

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What items should be included in the acupuncture first-aid kit?
A. Latex gloves, Forceps to remove broken needles, Endotracheal intubation
B. Latex gloves, Forceps to remove broken needles, CPR one page summary
C. Resuscitation barrier, Endotracheal intubation, CPR one page summary, Swiss army knife
D. Latex gloves, Resuscitation barrier, CPR one page summary, Forceps to remove broken needles

D. Latex gloves, Resuscitation barrier, CPR one page summary, Forceps to remove broken needles

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You take a coffee break and someone in the coffee shop begins choking. You perform the Heimlich Maneuver and the foreign object is dislodged. You find out later that the person suffered an abdominal rupture secondary to the performing of the Heimlich Maneuver. What is your liability, if any?
A) You are liable since you are on the clock.
B) You are liable for malpractice because it is a serious injury.
C) You are not liable because they did not die.
D) You are not liable due to Good Samaritan Laws.

D) You are not liable due to Good Samaritan Laws.

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Good Samaritan laws protect you where?

OUTSIDE a clinical workspace

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If an acupuncturist causes bleeding from a vein, what should be their course of action

Pressure for 30-60 seconds

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If an acupuncturist accidentally causes bleeding from a small artery, what should be their course of action

Pressure for 5 minutes

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This point on the radial end of the transverse crease of the wrist holds a risk for puncturing which artery?

LU9
Radial Artery

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This point at the ulnar end of the transverse crease of the wrist, in the depression on the radial side of the tendon of m. flexor carpi ulnaris holds a risk for puncturing which artery?

HT7
Ulnar

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The axillary artery should be avoided when needling which point?

HT1

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This point in the middle of the supraclavicular fossa, 4 cun lateral to the midline, holds a risk for puncturing which vessels?

ST12
Supraclavicular artery and vein

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This point at the lower border of the middle of the clavicle, 4 cun lateral from the midline, holds a risk of puncturing which artery?

ST13
Subclavian artery

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This window of the sky point on the anterior border of m. sternocleidomastoid, level with the Adam’s apple, holds a risk for puncturing which vessel?

ST9
Carotid Artery

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This point on the lateral side of the neck at the posterior border of m. SCM holds a risk for puncturing what vessel?

LI17
External Jugular Vein

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This point 6 cun superior to SP10 requires caution to avoid puncturing which artery?

SP11
Femoral artery

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This point lateral to the pubic tubercle, lateral and inferior to ST30, requires caution as it carries a risk for puncturing which vessels?

LV12
Femoral artery
Femoral vein

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This Earth point of the Foot Taiyang channel requires caution when needling due to its proximity to which vessel?

BL40
Popliteal artery

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This luo-connecting point 5 cun superior to the tip of the medial malleolus requires caution because of its proximity to which vessel and which nerve?

LV5
Saphenous Vein
Saphenous Nerve

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This Source point of the Foot Yangming channel requires caution when needling due to its risk of pricking which artery?

ST42
Dorsalis Pedis artery

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Shortly after needling your patient, they begin showing signs of nausea, dizziness, weakness, and small beads of sweat are showing on their forehead, what is most likely happening?

(Vasovagal) Syncope

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You remove needles from your patient and they start to sit up. As you are about to exit the room, they say they are lightheaded, dizzy, have slight ear ringing, and blurry vision. What is most likely happening?

Orthostatic hypotension

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You finish needling your patient and leave them to rest. When you check on them ten minutes later, they are dizzy, pale, nauseous, with a cold sweat, and palpitations. They share that they did not eat this morning. What is your course of action?

Remove all needles

Give warm water to drink and a snack if you have one

If slightly more severe, you can needle or moxa resuscitation points - Du26, P9, ST36, Du20, CV4, CV6

If no response, call 911

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An elderly patient has fallen in your clinic and hit their head on the floor. They tell you they are fine. What is your course of action and why?

Call 911 bc of risk of subdural hematoma

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A needle has broken, but it is exposed above the skin. What is your course of action?

Remove with forceps

A needle has broken. It is level with the skin. What is your course of action?

Press around the skin to expose the broken end and remove with forceps.

A needle has broken. The broken end is beneath the skin. What is your course of action?

Must be surgically removed by a physician.

What is the proper management of a stuck needle that cannot be removed?

Massage the nearby area or needle another point nearby to relax the muscle.

What is proper management of a bent needle?

Remove slowly in the direction of the bend

What are the most prominent signs of a pneumothorax?

Sharp, stabbing chest pain often worse with inhalation Dyspnea/ SOB

A small blister has formed after an indirect moxibustion treatment, what is the proper management?

Run cool water over the burn, apply sterile gauze, use surgical tape to keep gauze in place, or use a commercially prepared; adequately-sized bandage.

A large, deep red, somewhat wet-looking area has formed after indirect moxibustion treatment, what is proper management?

Consult or refer to a physician for care of second degree burn

After needling a patient on their abdomen, they call you several hours later to complain about abdominal pain, which is worse with movement and pressure, rigid, and bloated. They also have chills and fever with profuse perspiration, nausea and vomiting. What is most likely the cause and what is proper management?

Peritonitis Seek immediate medical attention

What headaches require immediate medical attention?

"Thunderclap" headaches Severe headaches with sudden onset

Deep puncturing on the low back may increase risk of puncturing what organ?

Kidney

Tenderness and pain in the lumbar area, bloody urine, potential coma are all signs of possible puncturing of which organ?

Kidney

A patient presents with a 103 degree fever, severe headache, neck stiffness, drowsiness, vomiting, and an inability to tolerate light, what is most likely happening and what is proper management?

Meningitis Call 911/ immediate emergency referral

Your patient was in a motor vehicle accident recently. They complain of low back pain and urinary and bowel incontinence. They have pain radiating down the leg and numbness around the anus. What is the likely condition and what is proper management?

Cauda Equina Timely referral to physician, as treatment requires surgical decompression

The majority of acupuncture adverse events are

Bruising and Bleeding; Pain/ Needle Site Pain (HB Kim says Infections, but that info is from 2000-2011)

The most common adverse events associated with acupuncture are

needle site bleeding, superficial hematoma, needle site pain

What drug may increase the tendency for bruising and bleeding?

Warfarin/ Coumadin/ Anticoagulant

A painful response to a normally innocuous stimulus is called

Allodynia

How does caffeine affect pain perception?

Caffeine may attenuate pain perception and build muscular strength performance during exercise, **but** may also heighten anxiety, and anxiety may lead to increased perception of pain

*[blank]* refers to aggravation of symptoms post acupuncture treatment, also known as "healing crisis."

Menken phenomenon

Pneumothorax that results from a compilation of a diagnostic or therapeutic intervention is called

Iatrogenic pneumothorax

Smokers, people with hx of lung cancer, people on corticosteroids are at increased risk for *[blank]*

Pneumothorax

On most patients, safe needling depth of the thoracic region to avoid pneumothorax is *[blank]* or less than the face width of a U.S. nickel

10-20mm

These four points are most frequently associated with pneumothorax

GB21 (30%) BL13 (15%) ST12 (10%) CV22 (10%)

The apex of the heart is located at this IC, close in proximity to which acupuncture point?

5th IC KD22

Needling these two points are prohibited on an infant

Du22, Du23

Infection that comes from the client themselves is called

Autogenous/ Endogenous infection

The source of exogenous infections?

Any source other than the patient themself. I.e. hospital personnel, hospitals, other patients, etc.

You open a 10-pack of sterilized needles for your first patient. You use four needles. The remaining six needles *[blank]*

Must be discarded

If needle stabilization is needed, practitioner should use *[blank]* to stabilize the needle

STERILE cotton or STERILE gauze

What volatile compound in moxa may elicit nausea or allergic reaction?

Borneol

Moxa burns larger than *[blank]* should consider a referral to a medical practitioner

1 cm

Patients with a history of *[blank]* and *[blank]* may have a limited response to pain or sense from the heat of moxa or a heat lamp

Diabetes Neuropathy

Cups are typically left on for *[blank]* minutes but can be left on for up to *[blank]* minutes

2-10 minutes, 20 minutes

The most common adverse outcome of cupping is

Bullae

Cupping should not be applied *[blank]* hours before chemotherapy or *[blank]* hours after chemotherapy

48, 24

What kind of metal needles should be avoided for electroacupuncture

Silver ## Footnote Silver is a soft needle that may electrolyze in the body very quickly and cause a toxic reaction

The current used for electroacupuncture ranges from *[blank]*

0.5 - 6 mA

Name five anatomical considerations that should be avoided to prevent adverse events from electroacupuncture

1) Anterior triangle of the neck d/t carotid sinus, laryngeal muscles, and vagus nerve 2) Posterior cervical area d/t brainstem 3) Crossing midlines - left to right or front to back 4) Crossing the heart 5) Any patient with implanted medical devices

What is **not** a component of CNT: A) Hand Sanitation B) Putting on sterile gloves C) Establishing and maintaining a clean field D) Skin preparation

B) Putting on sterile gloves

What is **not** a component of CNT: A) Isolation of contaminated sharps B) Heed standard precautions C) Sterile single-use needles; sterile instruments such as seven-star hammers, press tacks, intradermals, and lancets D) Preparing to excise a needle in the event of a broken needle beneath the skin

D) Preparing to excise a needle in the event of a broken needle beneath the skin ## Footnote If a needle breaks beneath the skin, you must refer to a physician

Acupuncture is a (CLEAN/ STERILE) procedure

CLEAN

Alcohol-based hand sanitizer must contain at least what % of alcohol?

60% ## Footnote 70% isopropyl to sanitize insertion site

According to CNT, one should scrub their hands for how long?

10-15 seconds

According to CDC, one should scrub their hands for how long?

20 seconds

A clean field must be established how often?

For each patient

How often should surfaces throughout the office (not the treatment bed) be cleaned with low-level disinfectant?

At least once daily

Cups or gua sha tools should be disinfected with (HIGH/ INTERMEDIATE/ LOW) level disinfectant?

High or intermediate High if there's blood or body fluids on the tools

Why shouldn't isopropyl/ ethanol have a higher than 70% concentration?

If alcohol is at a concentration higher than 70%, it evaporates too quickly to have an antiseptic effect

The same swab may be used on multiple points, but when should the swab be changed?

-If cotton swab should start to change color -If cotton swab becomes visibly dirty -If the swab comes in contact with lesions or wounds -If the axilla or groin needs to be swabbed

One should assume that all patients are a source of infection (T/F)

True

If the practitioner needs to stabilize a three to six inch needle, the shaft may be held with

Sterile gauze or cotton

Needles must be removed and placed in a sharps container one at a time (T/F)

False - although needles must immediately be placed into a sharps container, there is no evidence that needles need to be removed and disposed of one at a time; though limiting time and distance between removing the needle and placing used needles in the sharps container is strongly recommended

Which bloodborne pathogen is most likely to be passed by needlestick exposure?

HBV/ Hepatitis B Virus

Replace the sharps container when it is _ full

3/4

If a patient faints while sitting up, what four steps should the practitioner follow?

1) Remove needles immediately, legs elevated and the head lowered 2) Recommended that patients be placed safely on the floor if possible - making sure airways are not obstructed 3) Acupuncturists may use a finger to press Du26 to help revive the patient 4) Calling for medical help may be necessary in some cases

What is current practice for a very small first degree burn from moxa?

1) Run cool water over the burn (NEVER ICE), then apply sterile gauze secured to the skin with medical tape 2) Over-the-counter burn creams may also be used as per the package directions 3) Refer to a physician if the burn is severe or if there is concern with infection ## Footnote Ice may cause frostbite

To mitigate the exposure to moxa smoke, a room with proper ventilation, or use of a _ is appropriate when moxa is being performed

HEPA Filter

Taking extra precaution to identify patients' hx of neuropathy or any other condition that may diminish their response or to pain or heat is (CRITICAL/STRONGLY RECOMMENDED) when doing moxa?

CRITICAL

Staying in the room at all times during moxa therapy is (CRITICAL/STRONGLY RECOMMENDED)

CRITICAL

It is (CRITICAL/STRONGLY RECOMMENDED) that the practitioner not attempt to multitask during moxa therapy

STRONGLY RECOMMENDED

Rooms in which moxa therapy occurs being equipped with a fire extinguisher is (CRITICAL/ STRONGLY RECOMMENDED/ RECOMMENDED)

RECOMMENDED

When performing direct moxa, the moxa should be removed when the patient feels a burning discomfort or when the moxa is [_/_] burnt? A) 1/4 B) 3/4 C) 2/3 D) 1/2

C) 2/3

Weakness of the SP/ST, such as diarrhea, abdominal pain, painful joints, and symptoms due to Yang deficiency are indications for using moxa with _ ?

Ginger

Scrofula, tuberculosis, the early stage of skin ulcer with boils, poisonous insect bites are indications for using moxa with _ ?

Garlic

Yang collapse, abdominal pain, vomiting and diarrhea, pain around the umbilicus, pain caused by hernia, prolonged dysentery are indications for using moxa with _ ?

Salt ## Footnote Note: Yang collapse FORMULAS have Fu Zi, but when using moxa, using SALT is better than Fu Zi

Persistent Yin-Cold syndromes (such as impotence, premature ejaculation d/t Mingmen Fire decline) are indications for using moxa with _ ?

Fu Zi

It is strongly recommended that heat lamps be positioned at least _ inches from the area to be heated

It is recommended that heat lamps be set for no longer than _ ?

10-15 minutes

How long should moxa sticks be contained in an extinguisher after use?

At least one hour

Which two Hepatitis viruses have fecal-oral transmission and abrupt onset?

Hepatitis A Hepatitis E

Which Hepatitis Virus is especially dangerous for pregnant people?

Hepatitis E

Which two Hepatitis viruses have a bloodborne or sexual transmission and insidious onset?

Hepatitis B Hepatitis C

The CDC strongly recommends that healthcare workers be vaccinated for which Hepatitis virus?

HBV

The Hepatitis _ vaccine is recommended in communities where an outbreak is likely to happen

The Hepatitis _ virus can live outside the body for months, but can be killed by heating >185 deg F for one minute

This Hepatitis virus can stay on a surface for ~ 1 week

HBV

The most common chronic bloodborne viral infection is

HCV ## Footnote via injection drug use

HDV requires concurrent _ infection for the disease to develop

HBV

The more virulent, pathogenic, widespread HIV virus is

HIV-1

Most common bacterial contaminant found on skin?

staph. epidermis staph. aureus

~80% of MRSA infections are (NOSOCOMIAL/ COMMUNITY-ACQUIRED)?

Nosocomial - acquired after a 48-hour stay at the hospital with no previous documentation of a positive MRSA culture

MRSA can live on inanimate, dry surfaces for up to _ days.

90 days

Skin preparation with alcohol prior to injection is not absolutely necessary (T/F)

True

Acupuncture is not considered an exposure-prone invasive procedure for HIV (T/F)

True

Treatment tables and chairs should be disinfected how often?

Between each patient visit

The CDC accepts household bleach as a suitable instrument disinfecting solution in the healthcare setting (T/F)

FALSE If bleach is used, it MUST be medical grade

Chemical agents that kill or inhibit the growth of microorganisms on inanimate objects are called

Disinfectants

Chemical agents that kill or inhibit the growth of microorganisms on animate objects are called

Antiseptics

If a needle falls on the floor, the practitioner should pick it up with _

Hemostats

Sharps containers must be what color and be labeled with what symbol and what words?

Red Biohazard symbol "Biohazard: Regulated Medical Waste"

A sink with hot and cold running water must be located _ the treatment rooms

In or near

What should patients do with press tacks or other embedded devices that they need to remove at home?

Have patient return to office for the practitioner to remove and dispose of properly -OR- Give the patient a sharps container to take home, use it for intradermal needles when removed at home, and then return the sharps container to the practitioner

What are the five basic elements required in an informed consent?

1. Diagnosis 2. Nature and purpose of the proposed procedure or treatment 3. Risks and consequences of the proposed procedure or treatment (potential risks that occur more than 1% of the time) 4. Reasonable Tx Alternatives 5. Prognosis without Tx

Should pressure be applied before and during needle **removal**?

No Increases the risk for needlestick injuries; apply pressure to the acu point only AFTER the needle has been completely removed from the site

It is acceptable to just change the table paper over linens between each patient (T/F)

False The linens must also be changed and the table disinfected; mycobacterium outbreaks may have been associated with practices of reusing linens

What is the correct order of steps for cleaning cups or gua sha devices?

1. Clean the device with soap and water first 2. Disinfect with an intermediate level disinfectant 3. Rinse (if desired) to remove any remaining disinfectant

What fluids are considered potentially infectious?

Blood OPIM (Other Potential Infectious Materials): synovial fluid, amniotic fluid, semen, vaginal secretions, saliva, peritoneal fluid, pericardial fluid, fluids visibly contaminated with blood or fecal material

Which fluids are NOT known to be a source for HIV infections? A) Blood and Semen B) Breast Milk C) Sweat and Urine D) Amniotic Fluid and Synovial Fluid

C) Sweat and Urine

According to the CNT Manual, it is acceptable to remove needles and place them in a secondary container or receptacle prior to disposing them into a sharps container (T/F)

False Removing multiple needles at a time is acceptable as long as there is extra care taken to ensure that the needle will not come back into contact with the patient's skin, but they must go directly into a sharps container after removal.