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OSCE > LA > Flashcards

LA Flashcards

1
Q

WHAT DO YOU PALPATE WHEN DOING AN IDB

A

coronoid notch
ascending ramus
pterygomandibular raphe

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2
Q

HOW DO YOU ASPIRATE

A

push forward a tiny bit and let go

look for blood

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3
Q

WHY ASPIRATE

A

to avoid injecting LA into the BV

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4
Q

HOW LONG SHOULD YOU BE INJECTING IN AN IDB

A

30-45seconds

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5
Q

WHEN DOING AN IDB HOW MUCH OF THE CARTRIDGE SHOULD U DEPOSIT BEFORE RETRACTING

A

2/3 - last bit for lingual nerve - continuously injecting as retracting out the tissue

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6
Q

HOW LONG TIL FULLY ANAESTHETISED AFTER IDB

A

3-4 mins

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7
Q

HOW DO YOU DISPOSE OF THE NEEDLE

A

re-sheath - 1 click
secure - 2 clicks
remove the LA cartridge - blue bin
needle in orange bin

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8
Q

WHICH LA CANT BE USED IN PREGNANT WOMEN

A

prilocaine as it contains felypressin

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9
Q

WHAT DOES FELYPRESSIN DO TO PREGNANT WOMEN

A

induces labour

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10
Q

WHICH VASOCONSTRICTOR HAS CONSIDERATIONS WITH HEART PATIENTS AND WHY

A

adreneline as it can cause heart palpitations when acting on alpha receptors

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11
Q

IN WHAT SCENARIO WOULD YOU USE ARTICAINE OVER LIDOCAINE

A

when you are trying to anaesthetise a bigger area with less injections / avoiding a palatal as articaine is 4% compared to 2% lidocaine ( same vasoC)

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12
Q

WHY DOES FELYPRESSIN LA’S WASH OUT FASTER THAN ADRENLINE ONES

A

as adrenaline provides haemostatic control which means it doesn’t wash out as fast

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13
Q

WHAT CAN HAPPEN IF WE INJECT TOO STRAIGHT ON FOR AN IDB

A

hit parotid gland which contains facial nerve causing bells palsy

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14
Q

WHAT TO DO IF YOU GIVE THEM BELLS PALSY

A

don’t panic, pretty normal

send home with eyepatch so eye doesn’t dry up as cant close on own

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15
Q

HOW TO TELL THE DIFFERENCE BETWEEN A STROKE AND LA INDUCED PALSY

A

stroke = can still use forehead muscles

bells palsy = cant move anywhere on that side, all droopy

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16
Q

WHEN GIVING LA WHICH HAND IS USED FOR WHICH ACTION

A

dominant hand to inject

non dom to retract tissues

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17
Q

WHICH LA INJECTION WOULD HAVE THE PATIENT LYING THE FLATTEST

A

palatal
then buccal
then IDB

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18
Q

WHAT ARE THE MAIN LA PREPARATIONS

A

lidocaine 2% HCl = + 1:80000 adreneline
prilocaine 3% HCl + felypressin (0.03U/ml)
articaine 4% + 1:200000 adreneline

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19
Q

WHAT IS THE RESTING MEMBRANE POTENTIAL

A

-70mV

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20
Q

WHAT IS DEPOLARISATION OF AXON CAUSED BY

A

influx of Na+ ions through ion gated channels into the cell

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21
Q

WHAT IS REPOLARISATION CAUSED BY

A

efflux of K+ ions through ion gated channels

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22
Q

WHY IS THERE A REFRACTORY PERIOD IN ACTION POTENTIALS

A

as the Na+ ion channels are inactivated from previous AP

so AP cant propagate

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23
Q

IS THE ICF NEGATIVE OR POSITIVE

A

negative - more K+

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24
Q

WHAT FEATURES OF AN AXON MAKE IT HAVE QUICKER CONDUCTION SPEED

A

larger and myelinated

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25
Q

WHAT IS SALTATORY CONDUCTION

A

the AP passes along myelinated axons by skipping from one node of Ranvier to the next - fast

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26
Q

HOW DOES LA WORK PHYSIOLOGICALLY

A

blocks the Na+ voltage gated ion channels so depolarisation is blocked

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27
Q

WHICH AXON TYPES FUNCTION IS MOST LIKELY TO STILL BE FELT AFTER LA AND WHY

A

Aa as its the biggest axon with the most Na channels to be blocked so the least susceptible

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28
Q

COMPOSITION OF LA

A

the LA

  • aromatic region
  • ester or amide bond
  • hydrophilic region

reducing agent
preservatives / fungicides
vasoC

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29
Q

WHICH COMPONENT OF LA IS HYDROPHOBIC AND WHY DO WE NEED IT

A

the aromatic region

to pass through the membrane

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30
Q

WHY DO WE NEED A HYDROPHILIC REGION OF LA

A

to be soluble in water to be in an injection solution

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31
Q

WHY DO WE NEED A HYDROPHILIC REGION OF LA

A

to be soluble in water to be in an injection solution

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32
Q

WHEN IS LA IN ACTIVE FORM

A

when it is ionised (has H)

after inside the cell

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33
Q

WHEN IS LA IN INACTIVE FORM

A

when its unionised (H removed)

when passing membrane

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34
Q

HOW IS LA WRITTEN CHEMICALLY

A

B.HCl

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35
Q

WHAT IS THE REDUCING AGENT IN LA

A

sodium metabisulphide

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36
Q

WHICH LA ARE ESTER BOND

A

benzocaine
cocaine
procaine

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37
Q

WHICH LA ARE ESTER BOND

A

benzocaine

cocaine

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38
Q

WHICH LA ARE AMIDE BOND

A

lidocaine
prilocaine
articaine

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39
Q

WHY DO LA SOLUTIONS NEED A VASOCONSTRICTOR

A

as LA work as vasodilators which washes the LA out faster

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40
Q

TYPES OF VASOCONSTRICTOR

A

adrenline

felypressin

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41
Q

WHAT IS THE EFFECT WHEN ADRENLINE WORKS ON ALPHA ADRENORECEPTORS

A

vasoconstriction

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42
Q

WHAT IS THE EFFECT WHEN ADRENELINE WORKS ON B1 ADRENORECEPTORS

A

heart palpitations when given systemically

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43
Q

WHICH RECEPTORS DOES FELYPRESSIN WORK ON

A

ADH - anti diuretic hormone - receptors

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44
Q

HOW IS LA INACTIVATED FROM TISSUES

A

washed out by blood supply
esterases
liver amidases

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45
Q

HOW LONG DOES LIDOCAINE LAST

A

infiltration = 60 min
block = 90 min
soft tissues = 3-5hours

46
Q

HOW LONG DOES PRILOCINE LAST

A

infiltration = 30-45 min
block = 60 min
soft tissues = 3-6 hours

47
Q

HOW LONG DOES ARTICIANE LAST

A

infiltration = 120 min
block = 75 min
soft tissues = 3-5 hours

48
Q

WHERE IS LA DEPOSITED IN INFILTRATIONS VS BLOCKS

A

around terminal branches of nerve
VS
beside nerve trunk

49
Q

WHY CANT WE DO INFILTRATIONS ON POSTERIOR TEETH IN MANDIBLE

A

bone is too thick for infiltration to anaesthetise pulp

50
Q

WHAT AREAS NEED ANAESTHETISED FOR EXTRACTION

A

everything = pulp, ging, surrounding soft tissues

51
Q

WHAT AREAS NEED ANAESTISED FOR EXTRACTION

A

everything = pulp, ging, surrounding soft tissues

52
Q

WHAT AREAS NEED ANAESTHETISED FOR A RESORATION

A

pulp and gingiva (clamp/dam)

53
Q

WHAT AREAS NEED ANAESTHETISED FOR SCALING

A

gingiva and sometimes pulp

54
Q

WHAT IS THE GAUGE

A

diameter of needle lumen

lower number = larger lumen

55
Q

SMALLER NEEDLE LUMEN ADVANTAGES

A

less deflection / reduced breakage risk / easier aspiration

56
Q

SHORT NEEDLE GAUGE AND LENGTH

A

gauge 30

length 20-25mm

57
Q

LONG NEEDLE GAUGE AND LENGTH

A

gauge 27

length 30-35mm

58
Q

LA CLINICAL PROCESS

A 
brief patient, consent 
check batch no, expiry date and correct LA 
make syringe 
adjust seat and light 
prep needle for use 
injection
make needle safe again and dispose
59
Q

HOW TO APPLY TOPICAL

A

dry mucosa
pea size on cotton wool
hold for 1-2mins

60
Q

2 TYPES OF TOPICAL GELS

A

benzogel 20%

xylonor gingiva gel (lidocaine 2%)

61
Q

WHAT IS A SUPRAPERIOSTEAL INJECTION

A

infiltration

62
Q

WHERE TO INJECT FOR A BUCCAL INFILTRATION

A

3/4mm above apex

slightly distal

63
Q

HOW LONG DO YOU WAIT BEFORE TESTING IF A BUCCAL INFILTRATION WORKED

A

2 mins

64
Q

LIMITATIONS OF A BUCCAL INFILTRATION

A

pathology limits such as abscess

dense bone limits

65
Q

ADVANTAGES OF A BUCCAL INFILTRATION

A

atraumatic
easy
high success rate

66
Q

WHY IS THERE MORE RESISTANCE IN A PALTAL INFILTRATION THAN BUCCAL

A

the mucosa is more tightly bound to the bone

67
Q

WHERE IS THE INJECTION SITE OF A PALATAL INFILTRATION

A

5-10mm palatal of centre of crown
or
midway between ging margin and deepest vault of palate

68
Q

delete

A

d

69
Q

WHY USE MIRROR BEHIND INJECTION SITE IN PALATAL INFILTRATION

A

to compress the mucosa and distract from the discomfort

70
Q

HOW TO DO A PALTAL INFILTRATION

A 
mirror 
needle at 45 degrees to injection site 
bevel towards tissue 
few mm in - if contact bone then withdraw 
0.2-0.4ml anaesthetic (1/8 cartridge)
look for blanched tissue
71
Q

WHAT LANDMARKS SHOULD YOU LOOK FOR WHEN DOING AN IDB

A

coronoid notch of mandible (thumb)
ascending ramus of mandible (fingers)
pterygomandibular raphe

72
Q

HOW TO CONFIRM ANAESTHESIA IN IDB FROM PATIENT

A

tongue and lower lip extending to midline on that side should feel different
but still feel pressure

73
Q

IDB PROCESS

A 
locate site 
inject 
hit bone and withdraw 
1cm of needle always visible 
aspirate 
inject for 30-45seconds 
do lingual nerve of way out
74
Q

WHY DO WE NEED TO DO A LONG BUCCAL INJECTION

A

as the buccal gingiva of the mandible is not innervated by the inferior alveolar nerve but the buccal nerve

75
Q

INFILTRATION FINGER RESTS

A 
maxilla = pinky of non injecting hand on chin 
mandible = thumb of non injecting hand to balance barrel on
76
Q

IDB FINGER RESTS

A

pinky of injecting hand around ramus of opposite side to injection
or
balance barrel on thumb of non injecting hand

77
Q

LIDOCAINE CONTRAINDICATIONS

A

heart block and no pacemaker
allergy to LA or corn
hypotension
impaired liver function

78
Q

INDICATIONS FOR ARTICAINE

A

better than lidocaine for mandible infiltrations

when trying to minimise the amount of injections as its stronger than lidocaine

79
Q

ARTICIANE CONTRAINDICATIONS`

A

stronger preparation increases risk of non-surgical parathesisa
sickle cell disease/ other haemoglobinopathies

80
Q

SYSTEMIC COMPLICATIONS OF LA

A 
stress
cross infection
allergy 
collapse 
toxicity 
pregnancy 
other drugs : diuretics
81
Q

WHICH DRUGS INTERFERE WITH LA

A

MAOI : metabolises adreneline
tricyclics : hypertension
b blockers : reduce vasoC as on B2 adrenoreceptors
non potassium sharing diuretics : adreneline lowers K even more

82
Q

WHEN TO AVOID LA WITH ADRENELINE

A

BP >200mmHg(systolic) / 155mmHg(diastolic)

83
Q

WHICH DISEASES SHOULD YOU BE CAREFUL WITH WHEN USING ADRELEINE

A

CVS disease
hyperthyroidsm
hypertension
drug interactions

84
Q

LOCAL COMPLICATIONS OF LA

A 
fails to anaesthetise 
bells palsy - hit parotid gland
pain 
IV injection = blanch/visual disturbance 
trismus - hit medial pterygoid 
prolonged anaesthesia 
haematoma - bleeding
broken needle 
infection
soft tissue damage 
contamination
85
Q

WHAT TO DO IF SOMEONE GETS BELLS PALSY

A

give them eye patch
stay clam
say it will last a few hours then wear off

86
Q

WHAT IS CHASING ANAESTHESIA

A

getting palatal anaesthesia by buccal infiltration then intrapapillary injection through until palate blanches

87
Q

WHAT IS INTRALIGMENTARY ANAESTHESIA

A

inject into ging sulcus

88
Q

WHAT IS INTRAOSSESOUS ANAESTHESIA

A

use stabident perforator to stab through mucosa and bone
then LA injected straight into the cancellous bone - miss out the dense cortical
fast but invasive

89
Q

WHAT IS A TOPICAL JET INJECTOR

A

releases LA at high pressure so some goes into soft tissues

scary and loud but no needle(good for bleeding diathesis)

90
Q

WHAT ARE ALTERNATIVE IDB TECHNIQUES

A

gow gates : open mouth inject higher to get trigeminal ganglion
akinosi technique : mouth closed and we pull cheek open, insert higher to get the trigeminal ganglion

91
Q

WHAT IS THE WAND TECHNIQUE

A

less scary as its held like a pen and lot shorter needle

step on peddle to release LA at steady rate which reduces pain and human error

92
Q

METHODS TO ACHIEVE SURFACE(SOFT TISSUE) ANAESTHESIA

A

physical = ethyl chloride
pharmacological = gel / controlled release devices / jet injectors
TENS /hypnosis

93
Q

WHAT ARE THE USES OF TOPICAL GELS

A 
pre injection
clamp
suture removal
exfoliating primary teeth 
subgingival scaling 
incision of abscess
94
Q

HOW TO ACHIEVE PALATAL ANAESTHESIA IN CHILDREN

A

chasing anaesthesia technique

95
Q

HOW TO GIVE AN INTRALIGMENTARY INJECTION IN A CHILD

A

ultrashort 32 gauge needle at 30 degress to the long axis of the tooth, insert into the mesio-buccal ging sulcus and give 0.2ml per root

96
Q

HOW TO DO A MENTAL BLOCK

A

inject in between the 2 premolars at the apexes

97
Q

DISADVANTAGE OF A MENTAL BLOCK

A

may need additional labial infiltration as incisors may have crossover of supply at midline

98
Q

ACTIONS TAKEN TO PREVENT COMPLICATIONS

A

aspirating
slow injection
dose limitation

99
Q

HOW TO TREAT TOXICITY

A 
stop
BLS 
call medical assistance
protect patient from injury 
monitor vital signs
100
Q

HOW MUCH OF A CARTRIDGE FOR A BUCCAL INFILTRAION

A

1/4

101
Q

HOW MUCH OF A CARTRIDGE FOR A PALATAL INFILTRAION

A

1/8

102
Q

SITE OF LONG BUCCAL INJECTION

A

paralell to occlusal plane
distal and buccal to the last standing molar
called retro molar fossa
operator sits at 8oclock

103
Q

WHICH NEEDLE USED FOR LONG BUCCAL INJECTION

A

long

104
Q

WHAT EQUIPMENT NEEDED FOR AN LA TROLLEY SET UP

A 
blue bin 
orange bin 
cotton wool roll
topical 
LA cartridge 
long USP needle 
short USP needle 
black handle with rubber bung
105
Q

HOW TO ASSEMBLE LA USP SYRINGE

A

remove sterile syringe from protective envelope
insert cartridge into syringe - gold end first
slide plunger to end of handle - make sure O-ring completely covered
line up the handle pins with syringe notches
push on
twist clockwise to lock
slide protective sheath backwards until clicks
remove needle cap
ready

106
Q

HOW DOES THE LA USP SELF ASPIRATE

A

small protuberance at the bottom of the barrel which depresses the cartridge diaphragm throughout injection procedure
when injection pressure is released diaphragm goes back to normal - this causes back pressure in the needle resulting in aspiration

107
Q

HOW CAN THE USER MANUALLY ASPIRATE THE LA USP SYRINGE

A

when the handle pulled back wards the o ring on the shaft creates a vaccuum providing active aspiration

108
Q

HOW TO REPLACE A CARTRIDGE FOR A NEW ONE ON THE SAME LA USP SYRINGE

A

protective sheath to first holding position
ensure plunger fully retracted from cartridge
rotate handle anticlockwise to unlock
carefully pull 2 components straight apart
insert plunger with o ring back in to remove cartridge
insert new cartridge

109
Q

WHY NOT USE THE SAME LA USP SYRINGE WITH MULTIPLE CARTRIDGES

A

can cause :
cannula penetration
canula breakage
self aspiration

110
Q

HOW TO DISMANTLE AN LA USP SYRINGE

A 
once procedure done 
protective sheath 2nd click
twist and remove handle from barrel
insert the plunger with silicone bung back in to remove cartridge 
dispose in sharps bins
111
Q

HOW TO DISPOSE OF DIFFERENT LA NEEDLE HANDLES

A

white single use = medical waste

blue resuable = reprocessed according to manufacturers instructions

112
Q

TROUBLESHOOTING WITH THE LA USP SYRINGE

A

if unloading required = unlock handle and separate - don’t bend
don’t hold hub to align bevel = may unlock syringe

OSCE (14 decks)

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