Exam II Lecture 10 Flashcards
what are some examples of local anesthetic complications?
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
with any complication associated with the administration of local anesthetic, what should be done?
a note should be included in the patient’s chart
what should you do if a needle breaks?
- keep your composure
- do not walk away from the situation
- try to locate the needle fragment
if a needle breaks and any part of it is visible and retrievable, it should be retrieved without ___
pushing it further into tissues
if a needle breaks and it is not visible, what should you do?
immediate OMFS referral
- inform the patient
- have the patient stay as still as possible (migration can occur)
- inform attending and have OMFS involved immediately
what are 5 ways that needle breakage can be prevented?
- 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
how should parasthesia (mechanical injury to nerve) due to local anesthetic complications be managed?
- 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
what are two main ways to prevent local anesthetic complications?
- strict adherence to injection protocol
- avoid mechanical trauma to nerve
how should you manage a situation if your patient gets facial nerve paralysis due to local anesthetic complications?
- 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
how can you prevent facial nerve paralysis as a result of local anesthetic complications?
needle tip should come in contact with bone
how can a patient with trismus be managed?
- examine the patient
- prescribe heat therapy
- advise patient to initiate physiotherapy
- chewing gum
- vazirani-akinosi block may provide relief
- record in patients chart
how can trismus be prevented?
- 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
what is the management for a patient with a soft tissue injury?
- analgesics for pain, as needed
- antibiotics as needed, if infection results (unlikely)
- lukewarm saline rinses
- petroleum jelly or other lubricant
how can soft tissue injury due to local anethstic complications be prevented?
- use a local anesthetic of appropriate duration
- warn the patient and advise against eating and drinking
- use a warning sticker
what are some ways a hematoma as a result of local anesthetic complications can be managed?
- 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
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?
- IA nerve block
- ASA nerve block
- incisive or mental nerve block
- buccal or palatal
- PSA
- apply pressure to the area where the hematoma is
how can hematomas from local anesthetic complications be prevented?
- 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
how should you manage pain on injection?
- listen to your patient
- no other management is necessary
how can pain on injection be prevented?
- 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
is burning on injection common?
yes
what are the causes of burning on injection?
- 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
how can you manage burning on injection?
inject slowly
how can pain on injection be prevented?
- consider using buffered solutions
- be patient and don’t get too hurried
- store carpules at room temperature
- avoid alcohol contamination (sterilizing agents)
how is infection due to local anesthetic complications managed?
- if local anesthetic remains ineffective, consider placing patient on antibiotics to resolve infection
- if infection is severe enough, consider incision and drainage
how can infection due to local anesthetic complications be prevented?
- use sterile disposable needles
- properly care for and handle needles
- properly care for and handle dental cartridges of local anesthetic
to avoid infection as a result of local anesthetic complications, what is the proper way to care for and handle needles?
- avoid contamination
- avoid multiple injections with the same needle
to avoid infection as a result of local anesthetic complications, what is the proper way to care for and handle dental cartridges of LA?
- use a cartridge only once (one patient)
- store cartridges aseptically in their original container, covered at all times
how is sloughing of tissues due to local anesthetic complications managed?
- reassure patient
- no formal management is needed
- but you can manage symtpoms with analgesics or NSAIDS
how is sloughing of tissues due to local anesthetic complications prevented?
- use topical anesthetics as recommended
- do not use overly concentrated solutions containing vasoconstrictors (epi 1:50,000 - green band)
everything you do to a patient must be ___
documented in the patient’s chart
*if it is not documented, it did not happen
what are 4 important things that must be recorded every time you administer anesthetics?
- type of LA used
- amount of LA used
- type of needle used
- injection type administered
how is allergy-induced edema due to local anesthetic complications managed?
- 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
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?
- 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
___ edema is potentially life-threatening
allergy-induced
- its degree and location are highly significant
- if airway becomes compromised, follow the rules for basic life support
how is allergy-induced edema prevented?
complete a thorough medical evaluation of patient before drug administration
___ tissues are the most common place for sloughing due to LA
palatal
___ describes patient and health professional interactions
duty
___ describes failure to act
breach of duty
___ describes the summation of actual cause and legal cause
proximate cause
___ describes the element of the cause of action
damage
___ describes obtaining the patient’s permission prior to acting
consent
