Complications Flashcards

1
Q

What are the systemic complications of LA

A

1) syncope
2) local anesthetic overdose
3) epinephrine overdose
4) allergic rxn
5) any potential medical emergency

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2
Q

What is the cause of syncope

A

Drastic drop in BP
Emotion response to injection

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3
Q

What is prevention to syncope

A

Pre-anesthetic assesment - identify fearful patients
- hide needle
- supine position

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4
Q

What are symptoms of syncope

A

Sweating, naseua, pallor, increased HR and RR

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5
Q

What are the treatments for syncope

A

Supine position
Administer ammonia caspule/oxygen
- cool damp cloth on forehead/neck
- monitor vitals
- reassurance - no standing/sitign

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6
Q

What is cause of LA overdose

A

Injection into vessel - most common
Administering too large of dose
Metabolism/excretion of LA is slow

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7
Q

How do you prevent LA overdose

A

Aspirate in 2 planes
Calculate MRD based on pt weight
Pre-anesthetic assemnt for LA selection

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8
Q

What are symptoms of LA overdose (low and high)?

A

Low overdose = CNS excitation
high overdose = CNS and CV depression

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9
Q

What is treatment for LA overdrive

A

Determined by onset and severty

  • most are mild rxns (no tx)
  • moderate/sever = stablize (ABCs) and activate EMS
  • rapid onset = more severe - activate EMS immediately
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10
Q

What is cause of epinephrine overdorse

A

1:50,000 concentration
IV injection
CV patients

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11
Q

What is epinephrine overdose prevention

A

Aspritae in 2 planes
Use lowest effective concentration
Pre-anesthetic assesment to identify CV patients

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12
Q

What are symptoms of epinephrine overdose

A

Fight or flight response - lasts 5-10 mins

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13
Q

What is the treatment for epinephrine overdose

A

Reassurance for healthy patients or
CV pts = prepare for medical emergency

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14
Q

What are causes of allergic reactions

A

Hypersensitivity rxn to:
- methylparaben (preservative used until 1980)
- sodium bisulfite (in vasoconstrictors)
- ester topical anesthetics

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15
Q

What is the prevention of allergic reactions

A

Pre-anesthetic assessment

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16
Q

What are the symptoms of allergic reactions

A

Delayed hypersensitivity (rash/itching)
Immediate hypersensitivity (anaphylaxis)

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17
Q

What is the treatment for allergic reactions

A

Delayed = antihistimine/document

Anaphlyaxis = immediate life-threatening rxn - stabilize pt (ABCs), activate EMS, document

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18
Q

What do local complications include

A

1) needle breakage
2) pain during injection
3) burning during injection
4) hematoma
5) facial paralysis (transient)
6) paresthesia
7) trismus
8) infection
9) edema
10) soft tissue injury
11) tissue sloughing

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19
Q

What is the cause of needle breakage

A

Sudden unexpected movement
Poor technique

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20
Q

What is prevention for needle breakage

A

Use 25 or 27g
Use long needle for IA block
Do not bed neelde
Do not insert needle to hub
Do not force needle

21
Q

What is treatment for needle breakage

A

Keep hands in patients mouth
Remove needle if visible
Refer to oral surgeon
*document!

22
Q

What is cause of pain during injection

A

Dull/barbed needle
Poor technique

23
Q

What is prevention of pain during injections

A

Inject slowly
Use topical
Use sharp needle
Use anesthetic at room temperature

24
Q

What is treatment for pain during injections

A

Reassure patient
Slow down delivery

25
What is cause of burning during injection
Contaminated/expired anestehtic Poor technique Haeted anestehtic solution
26
What is prevention of burning during injection
Inject slowly Check cartridge before use Store at room temp
27
What is treatment for burning during injection
Raeassure, slow down delivery
28
What is cause of hematoma
Puncture of blood vessel Bad technique Multiple needle penetrations
29
What is prevention of hematoma
Use 27 short for PSA - know antomy
30
What is treatment for hematoma
Apply ice/pressure immediately Inform patient of swelling/discoloration - 7-14 days - document
31
What is cause of facial paralysis
LA deopisted in parotid gland Bone not contacted during manidbular block
32
What is prevention for facial paralysis
Contact bone before depositing anesthetic
33
What is treatment for facial paralysis
Reassure patient Document (Maybe eye patch if cant close eye)
34
What is cause of paresthesia
-Trauma to nerve sheath (pt feels shock - but shock doesnt always meant this) -Edema/hemmorhage near nerve -Contaminated anesthetic (soaked in disinfectant) -Possible association with articaine
35
What is prevention of paresthesia
Minimize needle movement within tissue Do not soak carpules in disinfectant
36
What is treatment for paresthesia
Reassure pt and wait - 3 weeks to 3 months, possible a year - document
37
What is cause of trismus
Muscle trauma from multiple needle insertions Contaminated anesthetic
38
What is prevention of trismus
Use sahrp needle Deposit anesthetic slowly Store properly
39
What is treatment for trismus
Reassure patient - 2-3 days Moist heat (20 min on/off) Document
40
What is cause of infection
Contaminated needle/cartridge Administering anesthetic through infected area (like swelling)
41
What is prevention of infection
Sterile needle - replace if contaminated Store properly Do not inject infected are
42
What is tx for infection
Antibiotics after 3 days
43
What is cause of edema
Trauma Contaminated anesthetic Allergic reaction to LA/sodium bisulfite
44
What is prevention of edema
Good technique Pre anestehtic assement (ID allergies) Store properly
45
What is treatment for edema
NONE - resolves within 3-4 days
46
What is cause of soft tissue injury
Self inflicted - usually children/special needs
47
What is prevention of soft tissue injury
Select LA with appropriate duration Warn patients/parents
48
What is treatment for soft tissue injury
Analgesics (OTC) Antibiotics if severe Warm salt water rinses Vaseline for lips