Week 5

Question 1

Contrast onset and duration of cocaine and tetracaine

Answer 1

Cocaine
Onset: Immediate 
Duration: 30-120 minutes
Peak Effect: 3-5 minutes
Max dose: 200 mg

Tetracaine
Onset: Slow onset 
Duration: 30-60 minutes
Peak Effect: 3-8 minutes
Max dose: 50 mg or 200 mg (says 2 different things on 2 different slides)

Question 2

In what instances do topical anesthesia most likely carry the risk of systemic absorption?

Answer 2

over large areas

Question 3

What are the present day medical uses of cocaine?

Answer 3

Topical = vasoconstriction, used in nasal surgery, treat resistant epitaxis

Question 4

What are two present day uses of tetracaine drop?

Answer 4

Glaucoma testing AND removal of corneal foreign bodies

Question 5

What are the OTC uses for lidocaine gel/ointment?

Answer 5

Sunburns, insect stings, insect bites

Question 6

EMLA –How deep can it penetrate? How quickly does it work?

Answer 6

EMLA = “Eutectic” mixture of lidocaine (2.5%) and priolocaine (2.5%)
Penetrates to 5 mm!
Needs a full hour to get to full effect

Question 7

Can EMLA cream be used on mucous membranes?

Answer 7

YES! = won’t cause systemic toxicity

Question 8

What are the precautions for use of EMLA cream?

Answer 8

near the eyes, broken or inflamed skin, open wounds, to 2,000 cm2 or more of skin it can result in systemic effects in susceptible individuals

Question 9

What are common uses of EMLA cream?

Answer 9

Uses: 
Pain of venipuncture/injections
Superficial minor surgery
Pretreatment for infiltration anesthesia
Skin graft harvesting

Question 10

When applying EMLA, TAC, LAT & TLE what precautions does the “applier” need to observe? How do you know when if has produced an anesthetic effect? Potential complications?

Answer 10

Need to look for skin blanching? (For sure with EMLA) Blanching shows that there the anesthetic effect is complete- usually takes an hour.
Complications- 5% of wounds need supplemental infiltration is needed for complete anesthesia.
* applier needs to wear gloves to prevent absorption of drug into their fingertips

Question 11

Name “two” types of vapocoolants. What are their medical uses?

Answer 11

Ethyl Chloride
Numbs skin in prep for cutting or injection- effects last 15-60 sec

Ice: low-tech skin coolant that allows needle insertion or quick incision with min to low pain

Question 12

In anaphylaxis symptoms of respiratory involvement may include what sign/symptoms?

Answer 12

wheezing, coughing, dyspnea and sensation of chest constriction.

Question 13

In anaphylaxis CV symptoms include ?

Answer 13

hypotension, tachycardia, syncope and cardiac arrest.

Question 14

In anaphylaxis GI symptoms Include ?

Answer 14

nausea, vomiting, diarrhea and abdominal cramping.

Question 15

What are the cutaneous symptoms that may occur in anaphylaxis?

Answer 15

Urticaria (hives, wheals), pruritis, warmth, redness

Question 16

Contrast immediate onset and slow onset anaphylaxis.

Answer 16

Immediate = pt. experiences sx’s within minutes of exposure. **sooner the symptoms begin the more severe!
Slow (delayed) = sx’s occur from 15 minutes to several hours

Question 17

What are the likely early warning signs of anaphylaxis?

Answer 17

Sensations of warmth or flushing, itching, lightheadedness, sudden fatigue, sense of “something not being right”

Question 18

Know the protocol for treating early and late onset anaphylaxis.

Answer 18

ALWAYS START TX AND CALL 911!

Question 19

T or F: To open the flow valve (green round knob) on the oxygen tank to desired flow rate you turn it in a clockwise direction.

Answer 19

FALSE = to open the tank you turn it COUNTER clockwise

Question 20

What flow rate is generally considered to be safe for use in COPD patient? What is the risk(s) of higher flow rates?

Answer 20

Anything below 2L/min – should not exceed!!
Too much oxygen in and they have poor perfusion so because of the decreased rate of breathing it causes hypercapnia (excess CO2)

Question 21

Name three problems that may occur with administration of greater than 60% concentration of oxygen for greater than 24 hours.

Answer 21

In premature infants = retrolental fibroplasia = retinal damge = irreversible blindness
Depression of ventilator drive
Oxygen toxicity

Question 22

What are the “three” functions of a horizontal mattress suture?

Answer 22

• Helps relieve excessive pressure on the skin = reduced scarring
• Helps approximate and evert wound edges (better than vertical mattress)
• Provides hemostasis in a bleeding wound
  “Retention” or “stay stitch”
  Keeps stitches farther from wound edges

Question 23

What are the risks of horizontal mattress suture?

Answer 23

If stitch is pulled too tightly, tissue hypoxia and poor healing may result

Question 24

When should you remove horizontal mattress sutures?

Answer 24

Remove at time of surgery when other stitches are complete or a few days later when would healing has begun.