Mod 4: Local Anaesthetic Adverse Effects Flashcards
Appropriate Injection technique is required to maximize pt comfort during an injection and involves what?
- Tightly stretching skin at injection site
- Inject needle perpendicular to skin
- Rapid insertion of needle through skin
- Injecting solution slowly
- Using smallest yet effective volume
Appropriate equipment to be used to maximize pt comfort, this should be?
Highest gauge needle and smallest syringe possible for particular clinical situation.
Name 2 topical agents that may reduce pt discomfort during injection?
EMLA, ELA-max creams also ethyl chloride (cold spray) may be used
The addition of Bicarbonate to LA’s can be useful in reducing pt discomfort how? and in what quantity?
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
The closer to what temperature reduces pain of injection?
Body temperature 37 degrees C
How can a pt be distracted in order to reduce pain of injection?
- Talking to them.
2. Allowing pt to listen to music
Local adverse reactions can occur with LA’s, Name them.
- Nerve damage
- Tendon damage
- Vessel damage
- Tourniquet effect
- Broken needle
- Infection
- Intravascular Injection
Name the 3 systemic adverse reactions.
- Systemic Toxicity reactions
- Hypersensitivity reactions
- Vasovagal reactions
Systemic Toxicity has 2 stages, early and late, which present differently, how?
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
Prevention of systemic toxicity reactions involves?
- Avoid IV injection (aspiration)
- Assess liver function
- Calculate MSD
- Be aware of current Meds.
What enzyme is responsible for metabolizing LA?
Cytochrome P4503A4 enzyme
Specific Inhibitors of amide LA metabolism include?
Itraconazole, Ketoconazole (azole antifungals)
Erythromycin, clarythromycon, cyclosporin (macrolides)
Amprenavir, Indinavir, Nelfinavir, Ritonavir (HIV protease inhibitors)
Diltiezam, Mibefradil (calcium channel blockers)
Describe the treatment protocol for Systemic toxicity.
- Stop injection, withdraw allergen, reassure pt
- Activate emergency plan
- Time check determine if 911 assistance is required
- Maintain/establish airway
- O2 10l/min
- CPR if needed
- Tourniquet above injection site
- Convulsions - Valium 10mg PO or 5mg IV
- Establish IV
- Hypotension - Ephidrine 0.5mg IM or IV
- CV collapse - Atropine 0.4mg IV
- Document after incident or transfer.
Are allergic reactions more prevalent in ester’s or amide’s?
Esters
What is responsible for most LA allergies?
PABA
LA hypersensitivity usually occurs within how long?
30 mins of injection
Anaphylaxis causes wide spread mast cell degranulation triggered by an allergen characterized by?
Histamine release
Vasodilation
Bronchospasm
Hypotension ultimately CV collapse
Signs and symptoms of histamine release. and treatment.
S&S: Wheals, Hives, Pruritis
Rx:Benadryl (dyphenhydramine) 50-75mg IM
Decadron (dexamethasone phosphate) 4-8mg IM
Signs and symptoms of vasodilation and treatment
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
Signs and symptoms of bronchospasm and treatment
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
Rx protocol for Hypersensitivity/anaphylactic reactions.
- Stop injection, withdraw allergen, reassure pt
2.Activate emergency plan
3.Time check determine if 911 assistance is required - Trendelenberg position
- Maintain/establish airway
- 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 - Benadryl (dyphenhydramine) 50-75mg IM
12 Aerosol bronchodilator (ventolin)
13.Decadron 6mg IM
14.Establish IV - Document after transfer
What are signs and symptoms of Vasovagal attack?
Tachycardia
Diaphorysis (cool/clammy)
Pallor
Hypotension
Which LA can be used in Pregnancy? and what is its class?
Lidocaine, class B
In pregnancy when should LA be avoided?
In 1st trimester
