Hand specific questions Flashcards
Contraindications to replantation
- Mechanism (crush injury, mangled)
- Multiple levels of injury
- Zone 2, single digit injury
- Prolonged ischemia time with large muscle content
- mentally or medically unstable
Management of extravasation injury to the extremity after CT scan
- Mild symptoms: elevation and cold compress
- Severe symptoms (neurovascular compromise): elevate, measurement of compartment pressures and potential surgical decompression
Agents that are irritants in extravasation injury
(Irritants cause inflammation, pain, tightness or phlebitis, but no tissue necrosis)
- rboplatin, irinotecan, cyclophosphamide
Agents that are vesicant in extravasation injury
(causes blisters and tissue necrosis. may present with late tissue destruction and often need intervention)
- doxorubicin
- vincristine
- vinblastine
- mitomycin
- paclitaxel
- azathioprine
- acyclovir
Symptoms of extravasation injury
pain, erythema, swelling, tenderness, blistering, mottling/darkening of skin, firm induration, ulceration, no cap refill
Treatment of vesicant extravasation
aspiration through catheter, cold or hot packs. Do not use cold packs in vinca alkaloid extravasation
- Hyluronidase (for vinca alkaloids)
- Sodium thiosulfate (for cisplatin)
- tx with DMSO topical
- Dexrazoxane
Treatment of vasopressor extravasation
Phentolamine 5-10mg in 10-20ml NS into wound; Topical nitroglycerin over wound; elevation and hot compress
Treatment of epinephrine injection (epi pen)
phentolamine 0.5-4.5 mg in 5 ml NS. caution in fingers to avoid creating a compartment syndrome; topical nitroglycerin; elevate extremity
Treatment of hyper and hypoosmolar extravasation (TPN, calcium chloride, calcium gluconate)
Hyaluronidase 15-25 units intradermal or via catheter
Treatment of IV contrast extravasation
<50mL Low-osm: elevate and monitor
>50 mL Low-osm or High-osm: hyaluronidase
