Mod 4: Local Anaesthetic Adverse Effects Flashcards

1
Q

Appropriate Injection technique is required to maximize pt comfort during an injection and involves what?

A
  1. Tightly stretching skin at injection site
  2. Inject needle perpendicular to skin
  3. Rapid insertion of needle through skin
  4. Injecting solution slowly
  5. Using smallest yet effective volume
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2
Q

Appropriate equipment to be used to maximize pt comfort, this should be?

A

Highest gauge needle and smallest syringe possible for particular clinical situation.

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3
Q

Name 2 topical agents that may reduce pt discomfort during injection?

A

EMLA, ELA-max creams also ethyl chloride (cold spray) may be used

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4
Q

The addition of Bicarbonate to LA’s can be useful in reducing pt discomfort how? and in what quantity?

A

By increasing the LA’s pH closer to physiological pH may reduce pain at injection site. 1cc of bicarbonate to 10cc of drug for Lidacaine, 0.1cc per 10cc of bupivicaine

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5
Q

The closer to what temperature reduces pain of injection?

A

Body temperature 37 degrees C

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6
Q

How can a pt be distracted in order to reduce pain of injection?

A
  1. Talking to them.

2. Allowing pt to listen to music

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7
Q

Local adverse reactions can occur with LA’s, Name them.

A
  1. Nerve damage
  2. Tendon damage
  3. Vessel damage
  4. Tourniquet effect
  5. Broken needle
  6. Infection
  7. Intravascular Injection
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8
Q

Name the 3 systemic adverse reactions.

A
  1. Systemic Toxicity reactions
  2. Hypersensitivity reactions
  3. Vasovagal reactions
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9
Q

Systemic Toxicity has 2 stages, early and late, which present differently, how?

A

In early stage the CNS stimulation is apparent - restlessness, excitability.
In later stage the CNS depression is noted - dizziness, oral numbness, confusion, tinnitus, double vision, tremors, muscle twitching, convulsions, seizure, coma, respiratory collapse.
The leads to CVS depression - decreased myocardial contractability, bradycardia reducing output and hypottension

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10
Q

Prevention of systemic toxicity reactions involves?

A
  1. Avoid IV injection (aspiration)
  2. Assess liver function
  3. Calculate MSD
  4. Be aware of current Meds.
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11
Q

What enzyme is responsible for metabolizing LA?

A

Cytochrome P4503A4 enzyme

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12
Q

Specific Inhibitors of amide LA metabolism include?

A

Itraconazole, Ketoconazole (azole antifungals)
Erythromycin, clarythromycon, cyclosporin (macrolides)
Amprenavir, Indinavir, Nelfinavir, Ritonavir (HIV protease inhibitors)
Diltiezam, Mibefradil (calcium channel blockers)

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13
Q

Describe the treatment protocol for Systemic toxicity.

A
  1. Stop injection, withdraw allergen, reassure pt
  2. Activate emergency plan
  3. Time check determine if 911 assistance is required
  4. Maintain/establish airway
  5. O2 10l/min
  6. CPR if needed
  7. Tourniquet above injection site
  8. Convulsions - Valium 10mg PO or 5mg IV
  9. Establish IV
  10. Hypotension - Ephidrine 0.5mg IM or IV
  11. CV collapse - Atropine 0.4mg IV
  12. Document after incident or transfer.
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14
Q

Are allergic reactions more prevalent in ester’s or amide’s?

A

Esters

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15
Q

What is responsible for most LA allergies?

A

PABA

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16
Q

LA hypersensitivity usually occurs within how long?

A

30 mins of injection

17
Q

Anaphylaxis causes wide spread mast cell degranulation triggered by an allergen characterized by?

A

Histamine release
Vasodilation
Bronchospasm
Hypotension ultimately CV collapse

18
Q

Signs and symptoms of histamine release. and treatment.

A

S&S: Wheals, Hives, Pruritis
Rx:Benadryl (dyphenhydramine) 50-75mg IM
Decadron (dexamethasone phosphate) 4-8mg IM

19
Q

Signs and symptoms of vasodilation and treatment

A

S&S: Sweling of eyelids, lips, cheeks, pharynx, larynx, wheezing, cyanosis
Rx: Epinephrine 0.3-0.5mg of 1:1000 conc IM. q 15mins x 3
Benadryl (dyphenhydramine) 50-75mg IM
Decadron (dexamethasone phosphate) 4-8mg IM

20
Q

Signs and symptoms of bronchospasm and treatment

A

S&S: Wheezing, Dyspnea
Rx: Epinephrine 0.3-0.5mg of 1:1000 conc IM. q 15min x 3
Aerosol bronchodilator (ventolin, proventil) 2 puffs q 4-6

21
Q

Rx protocol for Hypersensitivity/anaphylactic reactions.

A
  1. Stop injection, withdraw allergen, reassure pt
    2.Activate emergency plan
    3.Time check determine if 911 assistance is required
  2. Trendelenberg position
  3. Maintain/establish airway
  4. O2 10l/min
    7.CPR if needed
    8.Epinephrine 0.3-0.5mg of 1:1000 conc IM. q 15min
    9.Tourniquet above injection site
    10.Epinephrine 0.2cc of 1:1000 conc Iat injection site
  5. Benadryl (dyphenhydramine) 50-75mg IM
    12 Aerosol bronchodilator (ventolin)
    13.Decadron 6mg IM
    14.Establish IV
  6. Document after transfer
22
Q

What are signs and symptoms of Vasovagal attack?

A

Tachycardia
Diaphorysis (cool/clammy)
Pallor
Hypotension

23
Q

Which LA can be used in Pregnancy? and what is its class?

A

Lidocaine, class B

24
Q

In pregnancy when should LA be avoided?

A

In 1st trimester