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DOH 210 > W5 LA > Flashcards

W5 LA Flashcards

1
Q

What are 6 reasons for LA failure?

A
  1. Inadequate dose.
  2. Acute inflammation: low tissue pH affects onset of action of LA.
  3. Injection into blood vessles.
  4. Inadequate patience
  5. Incorrect technique/unusual anatomy
  6. Expired LA or not stored adequately
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2
Q

Describe the volume of solution for the pterygomandibular space

A

Volume approx 3.6mls. By ↑ volume of lignocaine in asymptomatic teeth this does not result in faster onset.
However if patient who have symptoms of pulpitis ↑ vol helps.

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3
Q

What is the safest LA?

A

Lignocaine!

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4
Q

What are the causes of pain of injection?

A 
Careless technique.
Too rapid injection.
Subperiosteal injection (if bevel is not facing bone).
Sol too cold or hot.
Unintentional pricks, electric shock n.
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5
Q

How do you prevent pain of injection?

A 
Know your landmarks.
Good technique.
Inject slowley
Bevel facing bone.
Make sure LA is at room temp when injecting.
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6
Q

What are 2 sensitivity disorders?

A

Prolonged anaesthesia

Paraesthesia

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7
Q

How do sensitivity disorders manifest clinically?

A

Burning or tingling.

Persistent anaesthesia

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8
Q

Define paraesthesia

A

Tinging or pins and needles

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9
Q

Define Hyperesthsia

A

Increased sensitivity to noxious stimuli

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10
Q

Define dysesthesia

A

Pain to non-noxious stimuli

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11
Q

Physiologocally what causes nerve trauma?

A

Trauma to n. impairs n. conduction by needle or indirect.

Administration of LA from a cartridge contaminated with alcohol = irritation → odema.

Risk of n. damage is ↑ if repeat injections are given.

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12
Q

How do you prevent paraesthesia?

A

Adhere to injection protocol

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13
Q

How do you manage sensitivity disorders?

A

Speak to pt personally, advise it is not uncommon.
Transient will last 8 weeks (do not tell pt).
Document.
* if unresolved in 8 weeks may be irriversable

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14
Q

What are the causes of needle breakage?

A

Needle may have been bent first, and inserted to its entire length.
+ Sudden movement

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15
Q

How do you prevent needle breakage?

A

Larger gauge needles.
Do no insert all the way into hub.
Do not apply extensive lateral pressure whilst needle is inserted.

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16
Q

How do you manage needle breakage?

A

Remain calm, ask pt to remain still.

If you can see needle remove it. If not, document event and refer to maxiofacial surgeon.

Document!

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17
Q

What is a needle track infection?

A

If you inject into an area of inflammation or abscess you are at risk of introducing infection to surround healthy tissues.

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18
Q

Explain direct impact of needle track infection

A

Needle is contaminated when it perforates infected area, this needle is used to deposit sol into deeper and healthy needles.

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19
Q

Explain indirect impact of needle track infection

A

If LA deposited under pressure the for of administration might transport bacteria into healthy adjacent tissues.

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20
Q

Define trismus

A

Prolonged spasm of jaw muscles which impairs normal opening (muscles of mastication)

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21
Q

What is the cause of trismus?

A

IAN into medial pterygoid m.
Haemorrhage.
Bleeding into muscle following injection. May cause myotoxic response - necrosis

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22
Q

How do you prevent trismus?

A

Adhere to injection protocol.
Avoid repeat injections
Usee minimum effective vol of LA.

23
Q

What is the management of Trismus

A

Mild:
Interum - heat, saline rinse, analgesic. Dentist to prescribe muscle relaxant (ab in necessary).
Document

24
Q

How long would it take for trismus to disappear?

A

7-10 days

25
Q

If trismus is prolonged who do you refer to?

A

Maxofacial surgeon

26
Q

What is the cause of facial n. paralysis?

A

Introduction of LA into capsule of parotid gland, results in unilateral paralysis of muscles of facial xpression.

(By not touching the bone, bypassing the ramus into parotid capsule).

Itraogenic

27
Q

How do you prevent facial n, paralysis?

A

Adhere to injection protocol, elsure touching bone is felt prior to deposition of LA

28
Q

What are the causes of soft tissue injury?

A

Frequent lip biting, tongue or cheek.

29
Q

How do you present soft tissue injury?

A

Select LA appropriate for pt.
Cotton role in mouth.
Post OP instructions
DOCUMENT.

30
Q

What is the management soft tissue injuries?

A

Analgesics, saline mouth rinse, vaseline. If severe lacerations due to systemic involvement may need ab by dentist.

31
Q

What is the cause of haematoma?

A

Effusion of blood into extravascular space, most likely by accidently nicking a blood vessel.
(pterygoid plxus, PSA vessels, IAV vessels, mental vessels, can occur in pterygoidmandibular space)

32
Q

How do you prevent haematoma?

A

Good knowledge of anatomy

33
Q

how do you manage haematoma?

A

Apply direct pressure until bleeding stops.
Adivsee pt of soreness.
Apply ice (vasoconstricor) intermittently for first- hours (no heat).

34
Q

How long can haematoma last?

A

7-14 days

35
Q

What are causes of membrane lesions?

A

Prolonged ischemia of tissus as a direct result of vasoconstrictor, or reaction on mucous tissues to anaesthetic agent.

36
Q

How do you prevent mucous membrane lesions?

A

Only use topical for 1-2min, try not to useoverly concentrated vasoconstrictiors (ligno, articain)

37
Q

How do you manage if a patient presents with mucous membrane lesions?

A

Reassure patient, analgesics if required, saline mourth rinse, ointment

38
Q

What are other intraloral lesions?

A

Pts may report a couple of days after LA that ulcerations have dveloped, around injection.

Cause

39
Q

What are some causes of intraoral lesions?

A

Recurrent apthous stomatitis

Herpes.

40
Q

How do you manage intraoral lesions?

A

Manage pain, assure pt not bacterial but exacerbation, refer to dentist for script

41
Q

What are the symptoms of psychogenic ?

A

Syncope, panic attack, nausea, vomiting

42
Q

What is the cause of psychogenics?

A

Emotional disturbances stress and dear.

  • May lead to vaso-vagal response or effects of myocardial depression and vasodilation).
43
Q

How do you manage psychogenics?

A

If syncope, lay down and elevate legs.
Alert pt via sound and pain.
Calm the patient

44
Q

Define hypersensitivity reaction

A

Exaggerated response of patients immune system.

45
Q

What LA group can trigger an exaggerated response?

A

Esters: sensitivity to their metabolite, paraaminobenzoic acid.
Amides are used as alternatives in those pts.

46
Q

What systemic reactions can occur due to hypersensitivity?

A

Skin: itching, flushing, hives, oedema
GIT: cramps, nausea, vomiting, incontinence
Reespiratory: shortness of breath, cynosis
CVS: palpitations

47
Q

What is the managment of allergies?

A

Mild:
Ceas dx
Remove allergn
Give oral antihistamine.
→ if hypotension and evidence of anaphylaxis: cease dx. Remove allergen.
000, epipen, monitor vital signs, basic life support.

48
Q

What can cause toxisity?

A

Can be caused by sol. & vasoconstrictor.

49
Q

What are factors that impact risk of toxicity?

A 
Pt age and weight.
Medications
Does
Site of injection
Compromisd pt.
50
Q

What tissues may be excited by LA?

A

CVS

CNS

51
Q

What are symptoms in the CNS system?

A

Stimulation/pre-convulsive phase.

Warning signs, restlessness, tremor, confusion or agitation
++ Respiratory depression

52
Q

What are CVS complications

A

Increased LA can cause myocardial depression , then cardiac arrest.

Increased adrenaline causes vasoconstriction of coronary arteries, increasing risk of angina, myocardial infarction and possible cardiac arrest

53
Q

What are the warning signs of CVS complications>?

A 
↑↓ HR
↑↓ BP
Palpitations
Arrhythmias
Lightheadness
Loss of consciousness/fainting

DOH 210 (22 decks)

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