SPM 200 Skills Lab 6
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Transcript SPM 200 Skills Lab 6
SPM 200
Skills Lab 4
Local Anesthesia /
Digital Block
Daryl P. Lofaso, M.Ed, RRT
Clinical Skills Lab Coordinator
(Updated 12/2005)
Anatomy of Skin
Arteries of the Hand
Each hand has 4 digital
arteries.
• Common Digital Arteries
• Dorsal Metacarpal Arteries
• Palmar Metacarpal
Arteries
• Proper Digital Arteries
Nerves of the Hand
Digital nerves run
down the medial
and lateral sides
of each digit.
Standard Precautions
All patients are potentially infectious.
Good handwashing is the key to reducing
nosocomial infections
Wash before and after patient contact
Wear gloves, a mask, eye protection, face
shield and gown when contact with blood
or other body fluids is likely
(a more detailed description can be found at:
www.cdc.gov/ncidod/hip/blood/universa.htm)
Risks to You:
Hepatitis B, C & HIV
Risk after Needle Stick Exposure
Hepatitis B: 10-30%
Hepatitis C:
2%
HIV:
0.4%
(30%)
(3%)
(0.3%)
Management of Exposure
Wash immediately
Report incident to supervisor
(3 red tops & file incident
report)
Obtain history from the
source patient (HIV,
Hepatitis or risk factors)
Management of Exposure
Report to Employee Health or
Emergency Department (Charity
Fast Track or University
emergency)
Counseling will be provided
regarding the need for post
exposure prophylaxis (see CDC
recommendations from June 2001)
www.phppo.cdc.gov/cdcrecommends/AdvSearchV.asp
Indications Digital Block
Excellent anesthesia (dorsal and
volar)
Repair of Lacerations beyond
Metacarpal
Incisions and Abscesses and
Paronychia
Nail removal
Contraindications
Digital Block
Long procedure – short acting
Multiple injuries
Patient allergies
Commonly Used Anesthetics
for Wound Repair
Lidocaine w/epi & w/o epi
0.5 – 1.0 %
(Duration 1-2 hrs)
Prilocaine
0.5 - 1.0 %
(Duration 15-45 min)
Bupivacaine
0.25 %
(Duration 4-8 hrs)
Safe → Etidocaine → Bupivacaine → Lidocaine → Less Safe
Use of Epinephrine
Increase anesthetic delivery
Slow diffusion through tissue
Increase the max dose of anesthetic
burns (acidic)
Cut off circulation in areas (penis, digit,
tip of nose, earlobe
Complications of
Local Anesthetic - Tx
Blanching of nearby skin – Stop
Urticaria (hives) – Stop
Syncope w/o edema – Monitor HR &
BP
Arterial Puncture –Direct pressure
Systemic Toxicity – CNS deficits
Contraindications
Neuro Block
Pervious Reaction to Local Anesthetic
Liver Disease, Heart Disease, R/O
Amide-Based Anesthetics
Previous use of MAO inhibitors
Anesthetics will reduce healing in
wound
Warning Signs:
Systemic Toxicity
Tinnitus, numbness of tongue,
lightheadedness, drowsiness
Visual disturbances
Muscle twitching, convulsions,
coma, apnea
Digital Block
Injection Technique
Patient Injection Technique
Hints to Minimize
Patient’s Pain
Small Needle
Inject Anesthetic Slowly
Add Sodium Bicarbonate –
basic solutions decrease burn
Invasive/Non-Invasive
Procedure Notes
Proper Patient Identification
Site Verification
Pre / Post Medication Pain Control
Intra / Post-Procedural monitoring
Complications, if any
Management of complications