Quiz 2

-esters vs amides

-short vs long acting

-vasoconstrictor or not?

-volume

-concentration (kid vs old vs healthy)

-normal healthy

-routine care, stress reduction

-mild-moderate systemic disease (HBP)

-routine care, stress reduction, limit length of appt

-severe systemic disease, NOT incapacitating

-strict limiting of complex procedures, control stress, modifications needed

-incapacitating disease, constant threat to life

-emergency/palliative care only

-moribund client, not expected to live

-emergency life support

-clinically DEAD

-maintained for organ harvesting

-ASA III or IV

-decreased liver function

-limit AMIDE/dose of anesthetic

-ASA II or IV

-limit vasoconstrictors (.o4 mg per visit)***

-2 cartridges of 1:100,000 epi or 4 cartridges of 1:200,000 = .04 mg

-ASA III if stable

-reduce stress

-may use vasoconstrictors but LIMIT

-follow .04 dose

-evaluate for antibiotics

-use stress reduction

-can use vasoconstrictors

-avoid highly vascular areas for injections

-limit vasoconstrictor dose

-stress reduction

-monitor vitals

-use minimum effective dose of the agents

-monitor vitals

-limit dose of anesthetic to avoid toxicity

-may need to consider an ester

-increased risk of infection

-liver disease, AIDS, jaundice, alcoholism

-ASA III or IV

-limit dose of AMIDE (not vasoconstrictor)

-potential for toxicity

HYPER: more sensitive to amides & esp. vasoconstrictors. Limit dose & avoid vasoconstrictors if uncontrolled

HYPO: no worries if controlled with med, no modifications necessary

-vasoconstrictor may interfere with the action of insulin & glucose uptake

-hyperglycemia is possible

-limit use of vasoconstrictor

**esp insulin dependants

-do not use epinephrine within 24 hours!!

-may choose not to do treatment

-cocaine: NO VASOconstrictor/epi, but CAN give AMIDE

-no contraindications

-use stress reduction

-overdose to anesthetics may trigger seizures

-avoid use of vasoconstrictors (sodium bisulfites)

-SULFA is OKAY

-relative contraindication to elective care

-avoid care in first trimester

-use lidocaine with epi or prolicaine= category B

-transmitted GENETICALLY

-rise in Ca levels in muscle

-triggered by specific agents like general or local anesthesia

-signs: tachycardia, fever muscle rigidity, cyanosis

-consult physician, use amides in normal dose

-underproduction of the enzyme by the liver

-cant hydrolyze ester

-USE AMIDES

-increased risk of apnea with succinylcholine (intubation in surgery, muscle relaxant)

-oxygen carrying capacity of blood is reduced

-hereditary, congenital or acquired

-usually seen with intravenous injections

-errors in metab of prilocaine in LG dose

-triggers: ink, shoe polish, benzocaine, sulfonamides, nitrates, crayons

-4 hrs after use: lethargic, resp disease, cyanosis, gray skin

-treatment= methylene blue intravenous

-some inactivate the drug, others potentiate their action

-vasoconstrictors more often in the tissue

-use reference & physician consult

-tricyclic antidepressants=a RELATIVE contraindication

-LIMIT EPINEPHRINE, avoid others

-accentuate the vasoconstrictor

-elevated systolic blood pressue

ex: nardil

-unable to inactivate the vasoconstrictor

-RELATIVE contraindication

-minimize the dose of EPI

ex: thorazine

-antipsychotic, also for nausea

-inhibits the vasoconstrictor

-could become hypotensive

-limit EPI

ex: Lopressor

-impairs metabolism of lidocaine

-decreases hepatic flow

-unlikely to cause toxicity in single dose

-affects how much AMIDE to use because LIVER dysfunction...MINIMIZE AMIDE

ex: inderal

-HYPERTENSIVE response to EPI

-limit dose of EPI, MINIMIZE EPI

-monitor blood pressue

ex: insulin, orinase

-epinephrine conteracts meds, glucose uptake

-LIMIT use of EPINEPHRINE

-avoid ESTERS..more slowly metabolized

-topicals should be OK

-for myasthenia gravis, glaucoma

ex: bactrim, septra

-do not use ESTERS

-inhibits bacterial action..makes antibiotic less effective

ex: tagamet

-used for GI problems

-potential for toxic response to AMIDES

-limit the AMIDE

-most are only RELATIVE contras

-use the MINIMUM effective dose of the amide and vasoconstrictor

-seek consults and references

-NOT very many ABSOLUTE contras (ester allergy, cocaine use etc)

= clinical signs and symptoms resulting from over administration of local anesthesia

-most likely from intravascular injection

-incidnce is low & preventable

-blood levels of anesthetic are elevated

-CNS & CVS excitation to depression

-age (young & old)

-weight

-meds

-disease, hepatic and renal function

-genetics, enzyme production

-attitude, environment

-vasodilators

-great conc of dose = more mg

-route of administration

-rapid deposition = increase toxicity

-vascularity of area

-use of vasoconstrictors (epi makes it safer)

-determind by age, weight & physical status

-2-3 mg/lb recommended

-consider MRD & vasoconstrictor

-use the LEAST of the 2 (can have 4 anesthesia but only 2 epi = only use 2!)

-very sensitive to anesthetics

-blood levels > 4.5 ug/ml for overdose

-agitation to respiratory distress

-less sensitive to anesthetics

-5-10 ug/ml for miner alterations

-over 10 ug/ml for serious complications

-increased heart rate to cardiac arrest

-conscious, talkative, agitated, increased vital signs

-slow onset is 5 mins or more

-slower onset is more than 15 mins, lasts longer, increases in intensity could indicate abnormal biotransformation, renal dysfunction

-reassure client, get assistance

-give oxygen

-monitor vital signs

-anticonvulsant IV may be needed

-allow to recover, evaluate for transport

-toxicity>seizure>anticonvulsant

-rapid onset: within ONE minute, unconscious, may have convulsions

-slow onset: large dose, rapid absorption may have renal or hepatic dysfunction

-elevate feet, slightly supine

-protect from harm

-get emergency help

-use basic life support

-anticonvulsant if longer than 5 mins

-water for post seizure depression

-allow to recover, escort home

-too much vasoconstrictor

-intravascular injection

-idiosyncratic response: unusual individually particular response to the patient

-fear, anxiety, tense, restless, tremors, perspirationm, weak, dizzy, palor

-heart palpitations

-respiratory difficulty

-high BP and heart rate

-dysrythmias

-hyperventilation

-stop procedure

-position semi-erect to supine

-reassure client

-monitor vitals

-oxygen UNLESS hyperventilating

=hypersensitivity acquired through exposure to an allergan

-re-exposure heightens response

-uncommon with AMIDES

-likely due to preservative/antioxidant (sodium bisulfite in epi solutions)

-more common with ESTERS, watch topicals

-localized or generalized rxn

-mild to major

-immediate or delayed

-most common resp=DERMATOLOGICAL

-bronchospasms

-anaphylaxis

=MOST COMMON

-usually not life-threatening

-hives, itching, swelling

-face, hands, feet, lips, tongue, pharynx, larynx, genitalia

-delayed, localized

-60 mins or more

-administer oral antihistamine

-50 mg diphenhydramine (2 tablets at 25 mg each)

-medical consultation

-less than 60 mins

-.3 ml of 1:1000 epi (epipen) or 1:2000 for kids

-antihistamine IM (50 mg)

-med consult before discharge

-observe for one HOUR

-escort home if epi pen/parenteral drugs were used

-oral antihistamine follow up

-bronchospasms

-lower airway distress, wheezing, cyanosis

-laryngeal edema, swelling, obstructs airway

CALL 911!!!!

-semi erect position, supine for laryngeal edema

-give oxygen

-use epi or bronchodilator

-observe/monitor for one HOUR

-use epi 1:1000 IM if reoccurs

-oral antihistamine after recovery

-discharge or hospitalize

-hypersensitive body response

-happens QUICKLY!!

-progresses in 5-30 mins

-can be life threatening

-smooth muscle contractions, bronchospasms, GI, genitourinary

-respiratory distress

-CV collapse, pallor, palpitations

-hypotension, unconcious, cardiac arrest

-death due to laryngeal edema

-activate the EMS

-place in supine position

-give EPI

-monitor until help arrives

-follow up with physician

-oral anti-histamines

=most COMMON SYSTEMIC reaction

-contributors: emotional distress, hunger, exhaustion, heat, position, hypervent, coughing, severe cardiac conditions, drugs

-management: supine, feet up, oxygen, inhalant

=persistent anesthesia..resolves within 8 weeks & is rarely permanent

cause: trauma to nerve sheath, hemorrhage around nerve

problem: self injury due to loss of feeling, loss of taste with Li nerve involved

manage: tell pt its temporary, record incident & re examine every 2 months, consult after 1 YEAR

=motor disturbance of trigeminal nerve, spasm of mastication muscles, opening is hard

-minor but can be chronic

-cause: injection to muscles or blood vessels, hand in hand with hematoma, hemorrhage irritates, low grade infection

-prevent: good technique,limit penetrations & redirecting

-apply heat every 20 mins

-muscle relaxants

-anti inflammatory drugs

-movement therapy

=the effusion of blood into extravascular spaces

-bruising noted intra and extraorally

-increases in sizze until extravascular pressure equals intravasc or until clots

cause: nicking blood vessel, most common with high vascularity: PSA, IA and mental

-immediately apply pressure at the site of bleeding for 2 mins

-apply cold packs

-DO NOT APPLY HEAT ON SAME DAY!!

=anesthesia of 7th cranial nerve

-impairment of muscles of mastication

-TEMPORARY symptoms

cause: needle was directed too far posteriorly into PAROTID gland (poor IA or akinosi)

-temporarily loss of motor function

-unilateral

-unable to close the eye

-mostly a cosmetic problem

-lasts a few hours

-tell client its transient

-remove contact lenses

-manually close the eye

-review your technique!!