skin and joint injections

Question 1

risk of infection depends on what factors

Answer 1

pathogen type
route/type of exposure
amount exposed to
amount of infected blood exposed
post exposure Tx
specific immune response

Question 2

When do majority of needle stick injuries occur

Answer 2

during use and immediately after use or before disposal

Question 3

What are 2 common problems when giving someone an injection

Answer 3

fainting

allergic reaction

Question 4

major contraindications to injections

Answer 4

known hypersensitivity to drug, skin is inflamed, irritated or infected
if the patient is pregnant or breast feeding
stopper is latex and patient is allergic to latex

Question 5

is informed consent required for all injections

Answer 5

yes

Question 6

What is included in pre-procedure patient education

Answer 6

indications, potential risks, complications and side effects, alternatives and potential outcomes

Question 7

what are the 3 types of cutaneous injections

Answer 7

intradermal
subcut
intramuscular

Question 8

what are most intradermal injections

Answer 8

diagnostic purposes like TB

1 cc with 27 gauge 1/2” needle

Question 9

how are subcutaneous injections given

Answer 9

45-90 degree for slow sustained absorption

1-3 cc with 23-25 gauge 1/2- 5/8” needle

Question 10

How are intramuscular injections given

Answer 10

well perfused m at 90
rapid systemic action
vaccines like HepA/B MMR DPT
3 cc 21-25 gauge 1-1.5”

Question 11

What is the most common complication of giving injections

Answer 11

vasovagal syncope

Question 12

what are the absolute contraindications for joint injections

Answer 12

local cellulitis
septic arthritis
acute fracture
bacteremia
joint prosthesis
achilles or patella tendinopathies

Question 13

what is a fast acting local anesthetic

Answer 13

lidocaine

Question 14

what is the longer acting local anesthetic

Answer 14

bupivacaine (marcaine)

Question 15

what anesthetic do we use for nerve blocks

Answer 15

bupivacaine

Question 16

what is a short acting corticosteroid

Answer 16

hydrocortisone

Question 17

what articular conditions are treated with steroids

Answer 17

RA, OA, Gout, Ankylosing Spondylitis, Reite’s syndrome, Psoriasis

Question 18

what mechanisms are corticosteroids believed to help articulations

Answer 18

increase viscosity of synovial fluid
alterations in neutrophil chemotaxis and function
stabilization of cellular lysosomal membranes
alterations in synovial permeability
changes in synovial fluid leukocyte count and variability

Question 19

what are some of the bad adverse consequences of corticosteroids in joints

Answer 19

may accelerate normal aging and cause prearticular calcification
tendon rupture

Question 20

what position is the patient in for a joint injection

Answer 20

supine

Question 21

65% of dorsal wrist ganglion arising from what joint

Answer 21

scapholunate

Question 22

what forms the triangle for injection or aspiration of the elbow

Answer 22

lateral olecrenon, head of radius and the lateral epicondyle