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Dental Anesthesiology I > Exam II Lecture 10 > Flashcards

Exam II Lecture 10 Flashcards

1
Q

what are some examples of local anesthetic complications?

A

needle breakage, prolonged anesthesia or parasthesia, facial nerve paralysis, trismus, soft tissue injury, hematoma, pain on injection, burning on injection, infection, edema, sloughing of tissue, post-anesthetic oral lesions

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2
Q

with any complication associated with the administration of local anesthetic, what should be done?

A

a note should be included in the patient’s chart

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3
Q

what should you do if a needle breaks?

A
  • keep your composure
  • do not walk away from the situation
  • try to locate the needle fragment
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4
Q

if a needle breaks and any part of it is visible and retrievable, it should be retrieved without ___

A

pushing it further into tissues

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5
Q

if a needle breaks and it is not visible, what should you do?

A

immediate OMFS referral

  • inform the patient
  • have the patient stay as still as possible (migration can occur)
  • inform attending and have OMFS involved immediately
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6
Q

what are 5 ways that needle breakage can be prevented?

A
  • never use a short needle for an IAN
  • never use a 30 gauge needle for an IAN
  • never bend the needle at the hub
  • never use the soft tissues to bend the needle
  • be extra cautious when inserting needles in younger children or in extremely phobic adults or child patients
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7
Q

how should parasthesia (mechanical injury to nerve) due to local anesthetic complications be managed?

A
  • be reassuring
  • speak with patient personally
  • examine patient in person
  • keep an outstanding medicolegal record
  • re-evaluate every 2 months (normally resolves in 8 wks)
  • dental treatment may continue, but avoid re-administering local into previously traumatized region
  • contact your liability insurance carrier
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8
Q

what are two main ways to prevent local anesthetic complications?

A
  • strict adherence to injection protocol
  • avoid mechanical trauma to nerve
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9
Q

how should you manage a situation if your patient gets facial nerve paralysis due to local anesthetic complications?

A
  • reassure the patient
  • explain the situation is transient
  • contact lenses should be removed
  • eye patch to protect the eye
  • record the incident in the patient’s chart
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10
Q

how can you prevent facial nerve paralysis as a result of local anesthetic complications?

A

needle tip should come in contact with bone

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11
Q

how can a patient with trismus be managed?

A
  • examine the patient
  • prescribe heat therapy
  • advise patient to initiate physiotherapy
  • chewing gum
  • vazirani-akinosi block may provide relief
  • record in patients chart
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12
Q

how can trismus be prevented?

A
  • sharp, sterile needles
  • properly handle cartridges
  • aseptic technique
  • atraumatic insertion and injection technique
  • avoid repeat injections
  • use minimum effective volumes of local anesthetic
  • trismus is not always preventable
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13
Q

what is the management for a patient with a soft tissue injury?

A
  • analgesics for pain, as needed
  • antibiotics as needed, if infection results (unlikely)
  • lukewarm saline rinses
  • petroleum jelly or other lubricant
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14
Q

how can soft tissue injury due to local anethstic complications be prevented?

A
  • use a local anesthetic of appropriate duration
  • warn the patient and advise against eating and drinking
  • use a warning sticker
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15
Q

what are some ways a hematoma as a result of local anesthetic complications can be managed?

A
  • when swelling becomes evident, direct pressure should be applied
  • patient may be discharged once bleeding stops
  • do not apply heat to area for at least 4-6 hours
  • ice may be applied immediatley on recognition of hematoma
  • avoid dental therapy until it resolves
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16
Q

hematomas are more likely in areas that are more vascular. what are some of these areas that are associated with local anesthetic injections? if a hematoma arises, what should you do?

A
  • IA nerve block
  • ASA nerve block
  • incisive or mental nerve block
  • buccal or palatal
  • PSA
  • apply pressure to the area where the hematoma is
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17
Q

how can hematomas from local anesthetic complications be prevented?

A
  • know your anatomy
  • modify injection technique to accommodate patient’s anatomy
  • use a short needle for PSA
  • minimize the number of needle penetrations into tissue
  • never use a needle as a probe in tissues
18
Q

how should you manage pain on injection?

A
  • listen to your patient
  • no other management is necessary
19
Q

how can pain on injection be prevented?

A
  • adhere to proper techniques of injection
  • use sharp needles
  • use topical anesthetic properly before injection
  • use sterile local anesthetic solutions
  • inject slowly
  • temperature of the solution
20
Q

is burning on injection common?

A

yes

21
Q

what are the causes of burning on injection?

A
  • main cause is pH
    • less common with “plain” formulations (epi included is around 3.5, plain is about 6.5)
  • injecting too rapidly
  • contamination (alcohol or other irritate)
  • LAs that are warmed to body temperature can be interpreted as too hot
22
Q

how can you manage burning on injection?

A

inject slowly

23
Q

how can pain on injection be prevented?

A
  • consider using buffered solutions
  • be patient and don’t get too hurried
  • store carpules at room temperature
  • avoid alcohol contamination (sterilizing agents)
24
Q

how is infection due to local anesthetic complications managed?

A
  • if local anesthetic remains ineffective, consider placing patient on antibiotics to resolve infection
  • if infection is severe enough, consider incision and drainage
25
Q

how can infection due to local anesthetic complications be prevented?

A
  • use sterile disposable needles
  • properly care for and handle needles
  • properly care for and handle dental cartridges of local anesthetic
26
Q

to avoid infection as a result of local anesthetic complications, what is the proper way to care for and handle needles?

A
  • avoid contamination
  • avoid multiple injections with the same needle
27
Q

to avoid infection as a result of local anesthetic complications, what is the proper way to care for and handle dental cartridges of LA?

A
  • use a cartridge only once (one patient)
  • store cartridges aseptically in their original container, covered at all times
28
Q

how is sloughing of tissues due to local anesthetic complications managed?

A
  • reassure patient
  • no formal management is needed
  • but you can manage symtpoms with analgesics or NSAIDS
29
Q

how is sloughing of tissues due to local anesthetic complications prevented?

A
  • use topical anesthetics as recommended
  • do not use overly concentrated solutions containing vasoconstrictors (epi 1:50,000 - green band)
30
Q

everything you do to a patient must be ___

A

documented in the patient’s chart

*if it is not documented, it did not happen

31
Q

what are 4 important things that must be recorded every time you administer anesthetics?

A
  • type of LA used
  • amount of LA used
  • type of needle used
  • injection type administered
32
Q

how is allergy-induced edema due to local anesthetic complications managed?

A
  • administer epi
  • histamine blocker IM or IV
  • corticosteroid IM or IV
  • cricothyoidotomy if total airway obstruction appears to be developing (summon emergency medical services early)
  • evaluate the patient’s condition thoroughly
33
Q

if a patient gets allergy-induced edema from local anesthetic complications, how much epi should you administer for an adult? a child between 15-30 kg? what if they have respiratory distress?

A
  • adult - 0.3mg (0.3 mL of a 1:1000 epi solution)
  • child between 15-30kg - 0.15mg (0.15 mL of a 1:1000 epi solution) IM
  • 3mL 1:10,000 epi solution IV every 5 min until respiratory distress resolves
34
Q

___ edema is potentially life-threatening

A

allergy-induced

  • its degree and location are highly significant
  • if airway becomes compromised, follow the rules for basic life support
35
Q

how is allergy-induced edema prevented?

A

complete a thorough medical evaluation of patient before drug administration

36
Q

___ tissues are the most common place for sloughing due to LA

A

palatal

37
Q

___ describes patient and health professional interactions

A

duty

38
Q

___ describes failure to act

A

breach of duty

39
Q

___ describes the summation of actual cause and legal cause

A

proximate cause

40
Q

___ describes the element of the cause of action

A

damage

41
Q

___ describes obtaining the patient’s permission prior to acting

A

consent

Dental Anesthesiology I (9 decks)

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