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Pain Control > Local and Systemic Complications > Flashcards

Local and Systemic Complications Flashcards

1
Q

causes of needle breakage

A
  1. smaller needles
  2. bent needles
  3. defective needles
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2
Q

prevention of needle breakage

A
  1. do not bend
  2. do not insert the needle to its hub
  3. do not redirect the needle once it is inserted into the tissue
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3
Q

hub, shaft, bevel?

where are these?

A

hub - directly after the syringe adapter
then shaft
bevel at the end

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4
Q

hematoma example of?

A

systemic complicaton

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5
Q

most needle fractures occur during?

A

administration of IAN blocks

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6
Q

most needle fractures occur when using?

in who?

A

with a 30-gauge needles and in children who are reported to have moved suddenly and violently as the dentist gave the injection

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7
Q

should avoid burrying the needle up to…

A

the hub - so avoid burying any needle up to the hub

unless it is essential for the block

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8
Q

if you can see needle break / if you cant what do you do?

A

can see it – grasp the most proximal end of the needle fragment and remove it from tissue

cant see it – immediate refer patient to an apporpriate specialist

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9
Q

what types of needles should you not use in IAN?

A

30 - gauge or short needles

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10
Q

causes of pain on injection

A
  1. carelessness
  2. dull needle
  3. rapid deposition
  4. needles with barbs
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11
Q

prevention to limiting pain on injection

A
  1. proper technique
  2. sharp needles
  3. topical anesthesia
  4. inject slowly
  5. temperature of the solution should be at room temperature
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12
Q

causes of burning on injection

A
  1. pH of solution
  2. rapid injection
  3. contamination of the local anesthetic solution
  4. temperature of the solution
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13
Q

preventing burning on injection

A
  1. it is almost impossible to eliminate the mild burning sensation
  2. slowing the injection administration
  3. room temperature
  4. storage container without alcohol
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14
Q

ideal rate of administration

A

1ml/min

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15
Q

ideal rate of administration

A

1ml/min

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16
Q

Onpharma’s Onset

A

Designed for precisoin buffering of local anesthetic, which provides rapid onset of analgesia and less injection pain

sterile, nonpyrogenic solution of sodium bicarbonate (NaHCO3) in water for injection

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17
Q

Onpharma’s Onset added to?

A

Lidocaine with epinephrine as a neutralizing agent immediately prior to administration

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18
Q

causes of persistant anesthesia / paresthesia

A
  1. trauma to the nerve
    - secondary chemical injury (alcohol contaminated cartridge)
    - direct trauma with the needle
    - LA
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19
Q

Paresthesia

A

persistent anesthesia

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20
Q

preventing Paresthesia

A
  1. Proper injection protocol

2. proper care and handling of dental cartridges

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21
Q

most paresthesia resolves when?

A

within approx. 8 weeks

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22
Q

most paresthesia involves what?

A

the tongue followed by the lip

  • occurs more in tongue than lip
23
Q

keys to patient management with Paresthesia

A
  1. be reassuring – speak to them, arrange appointemnt, record the incident in chart
  2. examine the pt.
    - determine extend and degree - map out the affected area, record all findings
  3. reschedule the patient
  4. consider referring the patient (if necessary)
24
Q

articaine 4% used with lingual nerve block implication

A

had the most number of nerve injuries reported

25
Q

conclusion from study

A

suggests that paresthesia occurs more commonly after use of 4% LA formulations

26
Q

94/5% of problems occured with what block?

A

mandibular block

27
Q

what not to use for IAN block?

why?

A

articaine or prilocaine

Articaine and prilocaine have higher incidence of injury
Because has a higher concentration of LA that could damage or be toxic to the nerve

28
Q

trismus

A

defined as a prolonged, tetanic spasms of the jaw muscle by which normal opening of the mouth is restricted

MASSETER, TEMPORALIS, in MEDIAL PTERYGOID

29
Q

most effected muscle in IAN?

A

medial pterygoid

30
Q

causes of trismus

A

trauma to the muscles or blood vessels

intramuscular injection

hemorrhage

contaminated cartridges with alcohol

31
Q

preventing trismus

A
  1. use a sharp needle
  2. do not store cartridges in alcohol
  3. aseptic technique – no infection
  4. atraumatic technique
  5. avoid repeated injections
  6. use minimum volumes
32
Q

management of trismus

A
  1. arrange an appointment
  2. heat therapy
  3. warm saline rinses
  4. analgesic
  5. muscle relaxants
  6. physiotherapy
  7. record the incidence

no improvement after 48 hours - prescribe antibiotics

33
Q

no improvement in trismus after 48 hours?

A

prescribe antibiotics

34
Q

trismus due to infection or secondary to injection?

A

hard to tell so give antibiotics to treat

35
Q

hematoma

A

effusion of blood into extravascular spaces

due to a trauma to a blood vessel

36
Q

are there problems w/ hematoma

A

rarely produced significant problems

trismus and pain

becomes a problem if they do start bleeding - as airway could be compromised – so make note to this with patients that have bleeding issues

37
Q

hematoma prevention

A
  1. knowledge of the anatomy
  2. minimize the number of needle penetrations
  3. never use needle to probe
  4. use a short needle for PSA nerve block
38
Q

management of hematoma

A
  1. pressure
  2. ice
  3. time
  4. “do not apply heat”
39
Q

causes of infection

A
  1. contamination of the needle prior to administration of the anesthetic
  2. injecting local anesthesia into the effected area
40
Q

infection problem ?

A

relating to trismus and airway - this could be a problem

41
Q

edema?

causes?

A 
swelling of tissues 
causes
1. trauma
2. infection
3. allergy
4. hemorrhage
5. injection of an irritating solution
42
Q

edema from LA results in …

A

pain and dysfunction

43
Q

what if airway and breathing are compromised with edema?

A
  1. activate emergency protocol
  2. unconscious patient is placed in supine position
  3. basic life support
  4. active emergency medical service
  5. epinephrine – 0.3 mg adult
    0.15 mg child
    IM or IV q 5 minutes until respiratory distress resolves
44
Q

edema – airway breathing are compromised … administer

A

antihistamine - for inflammation

corticosteroids

cricothyrotomy

45
Q

cricothyrotomy vs treachostomy

A

trach-

cricothyro– emergency and needs to be fixed to a trach??

46
Q

causes of facial nerve paralysis

A

local anesthetic is injected into the capsule of the parotid gland

47
Q

prevention of facial nerve paralysis

A

correct your technique

48
Q

management of facial paralysis

A
  1. explain

2. eyepatch

49
Q

managemnt of facial nerve paralysis

A
  1. remove contact lenses
  2. record incident
  3. reschedule the patient
50
Q

3 principles to systemic complications

A
  1. no drug ever exerts a single action
  2. no clinically useful drug is entirely devoid of toxicity
  3. the potential toxicity of a drug rests in the hands of the user
51
Q

causes of adverse drug reactions

3 main ones

A
  1. toxicity caused by direct extension of the usual pharmacological effects of the drug
  2. toxicity caused by alteration in the recipient of the drug
  3. toxicity caused by allergic responses to the drug
52
Q
  1. toxicity caused by direct extension of the usual pharmacological effects of the drug break down
A
  1. side effects
  2. overdose reactions
  3. local toxic effects
53
Q
  1. toxicity caused by alteration in the recipient of the drug break down
A
  1. a disease process (hepatic dysfunction, CHF, renal dysfunction)
  2. emotional disturbances
  3. genetic aberrations (Atypical plasma cholinesterase, malignant hyperthermia)
54
Q

is allergy dose dependent?

A

no

but signs symptoms are similar between this and overdoes

Pain Control (12 decks)

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