Injections

Question 1

Indication of analgesia

Answer 1

During procedures

After trauam

Question 2

Indication of akinesia

Answer 2

Sub-tenons/tenons block

Question 3

Diagnostic local anesthesia

Answer 3

Isolate pathology

Question 4

Advantage of local analgesia

Answer 4

Easy to administer
Reliable
Safe

Question 5

Disadvantage of local anesthesia

Answer 5

May rewuire high volume of anesthesia

Painful
Distorts anatomy

Question 6

Topical analgesia pros

Answer 6

Painless

Does not distort anatomy

Question 7

Disadvantage of topical analgeia

Answer 7

Not always reliable
Excessive absorption if used on mucous membranes
Cannot be used on end arterieolat circualtion

Question 8

Nerve block advantage

Answer 8

Unlikely to distort anatomy

Fewer overall injections

Question 9

Disadvantage of neve block

Answer 9

Only for certain locations

Not as reliable as local

Question 10

Pharmacology of anesthesia

Answer 10

Weak base
Prepared in acidic solutions to prolong shelf life [H+]
Blocks Na channels preventing pain transmission
Buffering increases the availability of active particles of anesthetic (non-ionized form)

Question 11

Factors to influence pain upon injections

Answer 11

PH
Temp
Speed and depth of injection
Needle gauge

Question 12

Factors to reduce pain upon injections

Answer 12

PH: buffer solution with bicarbonate. 2,8-5.7x less painful, doesnt effect duration of anesthetic. Pretreat with topical anesthesia if possible

Temp: warm

Slow rate of injection and from inside the wound margins

Use a thinner gauge

Question 13

Buffering

Answer 13

1 part sodium bicarbonate 8.4% to 9 parts anesthetic. May appear cloudy doesnt affect the anesthetic

Use immediately
Warm to body temp

Question 14

Esters

Answer 14

Proparacaine
Tetracaine
Chloroprocaine

Question 15

Amides

Answer 15

Lidocaine
Etidocaine
Mepivacaine
Bupivacaine

Question 16

Which one causes more allergies, ester or amides

Answer 16

Esters

Question 17

Which injections do we use the most

Answer 17

Lidocaine and bupivacaine

Question 18

Factors affecting efficacy of anesthetic

Answer 18

Infection
Inflammation
Anxiety

Question 19

Infection and efficacy

Answer 19

Edema, tissue hypoxia

Question 20

Inflammation and efficacy

Answer 20

Ruptured chalazion

-inflammation, edema, tissue hypoxia

Question 21

Anxiety and efficacy of injection

Answer 21

Hyperventilation-resp acidosis, metabolic acidosis, tissue hypoxia

Question 22

Contraindications to local anesthesia

Answer 22

Hypersentisity 
Allergic to
-preservative
-ester anesthetic 
-Almide anesthetic 
History of CNS reactivity to a local
Histroy of cardio reactivity

Question 23

Preservative allergy

Answer 23

Formation of PABA

-methylparaben

Question 24

Allergy to ester

Answer 24

Formation of PABA during the metabolic process

• tetracain
• procaine

Question 25

Allergy to amide

Answer 25

Rare | Lidocaine

Question 26

Cross reaction between amides and esters

Answer 26

Little to no cross reaction between them

Question 27

history of CNS reactivity and local

Answer 27

``` Numbness Tinnitus Tremor Visual disturbance Altered mental state Seizure ```

Question 28

History of cardio and loca

Answer 28

Arrhythmia, bradycardia, tachycardia

Question 29

Contraindications to epinephrine

Answer 29

``` Beta blockers TCA MOAI Hypoglycemics/insulin Thyroid hormone Oxytocics ``` Hypersensitive to epinephrine Patietns with sulfate sensitiveity (added to epi to prevent browning of solution)

Question 30

Use of epinephrine

Answer 30

Prologues anesthetic and promotes hemostasis

Question 31

Comorbidities with epinephrine

Answer 31

``` Angle closure glaucoma Organic brain syndrome Coronary insuffiency PVS Labor and delivery ```

Question 32

Open contaminated wounds and epinephrine

Answer 32

Decreased blood flow Increase infection Don’t ever put epi on this

Question 33

Relative contraindications/caution

Answer 33

``` DM HTN Arteriosclerosis Thyrotoxicosis Heart block Cerebrovascualr disease ```

Question 34

Absolute contra to epinephrine

Answer 34

``` Fingers Toes Nose (ala nasi) Earlobes The penis ``` Few vascular beds there and can cause necrosis

Question 35

When to use lidocaine

Answer 35

``` Contaminated wounds Presence of a vascular disease Immunocompromised patient CV disease Cardio disease Nerve blocks ```

Question 36

Alternatives to allergic patietns

Answer 36

- no anesthetic - preservative free single dose - cooling agent (NOT IN THE EYE): ice, liquid nitrogen, ethyl chloride - substitute an amide for an ester - sub (both comparable to lidocaine 1% effect): sterile saline 0.9%. Benadryl 50mh/mL: STINGS and buffering doesnt help

Question 37

Benadryl for allergic patietns

Answer 37

50mg/mL -mix 1 vial with 4mL of sterile saline and draw it up and inject it DO NOT USE NERVE BLOCKS

Question 38

Complications of anesthesia

Answer 38

Redness Swelling Streaking Pus pain

Question 39

Managment of complaitions

Answer 39

Ab Steroids Hygiene

Question 40

Allergic reactions to anesthesia

Answer 40

``` Lightheadedness Nausea/vomiting Pruritis/urticaria Edema Hypotension/syncope Cardiovascular collapse ```

Question 41

Managment of allergic problems

Answer 41

Oral Benadryl for minor | Call 911 + epipen for severe

Question 42

CNS complications

Answer 42

``` Numbness Tinnitus Tremor Visual disturbance Altered mental state Seizure ```

Question 43

Managment of CNS problsmes

Answer 43

Call 911 Oxygen with a MASK Alert patietns may hyperventilate

Question 44

Cardio/pulmonary problems with anesthesia

Answer 44

``` Arrhythmias Bradycardia Respiratory distress Hypotension Exacerbation of CHF ```

Question 45

Magnsment of cardio/pulmonary probes

Answer 45

Call 911 Start BLC/CRP (ACLS for serious rhythm disturbance) ER

Question 46

Methemoglobinemia

Answer 46

High levels of methemoglobin in blood Renders RBC incapable of transporting oxygen. Cyanosis does not repsond to oxygen, arterial blood appears brown Infants and elderly most susceptible

Question 47

Steps for drawing up

Answer 47

Get ready Check you meds Get the vial ready Fill syringe

Question 48

Getting ready for draw

Answer 48

``` Gather and prep your supplies -vial -syringe and needle -alcohol pads -sharps container Clean work area -set up away from contaminated areas Clean hands ```

Question 49

Checking meds before draw

Answer 49

``` Check the label -correct medication, liquid, powder -expiration date-DO NOT USE IF EXPIRED Check color -color -precipitates -cloudiness If the medicine is to be used more than once, write the date on via to show opening date ```

Question 50

Getting the vial ready

Answer 50

Take cap off (if new bottle) Clean rubber septum with alcohol pad in a “one pass only” technique -do not rub in circles-contamination

Question 51

Filling the syringe

Answer 51

-hold the syringe like a pencil with needle pointing up -with the cap still on, pull the plunger to the designated line on the syringe to match your dose = draws in air (displace and equalize inside the vile) • With one hand, pierce the rubber septum with the needle • Push air into the vial (prevents a vacuum from forming) • Turn the vial and syringe upside down and hold it in the air (needle tip in medication) • Pull back plunger to desired dose • Replace vial to table • With one hand, remove need from bottle and replace cap using the “swoop” technique • Hold the syringe again like a pencil with the needle pointing up and gently tap the syringe to move air bubbles to the surface

Question 52

Handling sharps

Answer 52

– Sharps: Needles, scalpels, cutting tools – Prevent injuries • Have all appropriate items nearby such as alcohol swabs, gauze, bandages • Know where the sharps container is • DO NOT uncover or unwrap a sharp object until you are ready to use it • Never point the needle at yourself or other people • Never recap or bend a sharp object (Unless using “scoop” technique) • Never hand off an uncapped needle or lie it down for someone to grab

Question 53

Sharps disposals

Answer 53

• Container is at eye level and within reach • Puncture resistant with a lid and the color red • Replace when they are 2/3 full • Never put your fingers into the container or try to push down a syringe that is sticking partially out → Call to have the container removed • If you find an uncovered sharp near the container you can pick it up ONLY if you can grab the non-sharp end (if not use tongs, dustpan and broom, etc)