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Pain and Anxiety > Complications > Flashcards

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
Q

What is cause of burning during injection

A

Contaminated/expired anestehtic
Poor technique
Haeted anestehtic solution

26
Q

What is prevention of burning during injection

A

Inject slowly
Check cartridge before use
Store at room temp

27
Q

What is treatment for burning during injection

A

Raeassure, slow down delivery

28
Q

What is cause of hematoma

A

Puncture of blood vessel
Bad technique
Multiple needle penetrations

29
Q

What is prevention of hematoma

A

Use 27 short for PSA
- know antomy

30
Q

What is treatment for hematoma

A

Apply ice/pressure immediately
Inform patient of swelling/discoloration - 7-14 days
- document

31
Q

What is cause of facial paralysis

A

LA deopisted in parotid gland
Bone not contacted during manidbular block

32
Q

What is prevention for facial paralysis

A

Contact bone before depositing anesthetic

33
Q

What is treatment for facial paralysis

A

Reassure patient
Document
(Maybe eye patch if cant close eye)

34
Q

What is cause of paresthesia

A

-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
Q

What is prevention of paresthesia

A

Minimize needle movement within tissue
Do not soak carpules in disinfectant

36
Q

What is treatment for paresthesia

A

Reassure pt and wait - 3 weeks to 3 months, possible a year
- document

37
Q

What is cause of trismus

A

Muscle trauma from multiple needle insertions
Contaminated anesthetic

38
Q

What is prevention of trismus

A

Use sahrp needle
Deposit anesthetic slowly
Store properly

39
Q

What is treatment for trismus

A

Reassure patient - 2-3 days
Moist heat (20 min on/off)
Document

40
Q

What is cause of infection

A

Contaminated needle/cartridge
Administering anesthetic through infected area (like swelling)

41
Q

What is prevention of infection

A

Sterile needle - replace if contaminated
Store properly
Do not inject infected are

42
Q

What is tx for infection

A

Antibiotics after 3 days

43
Q

What is cause of edema

A

Trauma
Contaminated anesthetic
Allergic reaction to LA/sodium bisulfite

44
Q

What is prevention of edema

A

Good technique
Pre anestehtic assement (ID allergies)
Store properly

45
Q

What is treatment for edema

A

NONE - resolves within 3-4 days

46
Q

What is cause of soft tissue injury

A

Self inflicted - usually children/special needs

47
Q

What is prevention of soft tissue injury

A

Select LA with appropriate duration
Warn patients/parents

48
Q

What is treatment for soft tissue injury

A

Analgesics (OTC)
Antibiotics if severe
Warm salt water rinses
Vaseline for lips

Pain and Anxiety (12 decks)

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