Week Five - Questions

Question 1

What are the onset/peak effect, duration, and maximum doses of cocaine and tetracaine?

Answer 1

Cocaine

• Onset/peak effect: 3-5 minutes
• Duration: up to 120 minutes
• Max dose: 200 mg (5 cc)

Tetracaine

• Onset/peak effect: 3-8 minutes
• Duration: 30-60 minutes
• Max dose: 200 mg (2 cc)

Question 2

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

Answer 2

• When applied to denuded skin

- When applied to infants

Question 3

What are the present-day medical uses of cocaine?

Answer 3

• Primarily used in nasal surgery

- To treat resistant cases of epistaxis

Question 4

What are two present-day medical uses of tetracaine drops?

Answer 4

• For glaucoma testing

- For removal of corneal foreign bodies

Question 5

What are the OTC uses for lidocaine gel/ointment?

Answer 5

• Sunburns

- Insect stings or bites

Question 6

How deep can EMLA penetrate?

Answer 6

• 5 mm deep

Question 7

How quickly does EMLA work?

Answer 7

• Takes up to a full hour to produce a good effect

Question 8

What are the common uses of EMLA?

Answer 8

• Relieve pain of venipuncture/injections (esp chronic)
• Superficial minor surgery
• Pretreatment for infiltration anesthesia
• Skin graft harvesting

Question 9

Can EMLA be safely used on mucus membranes?

Answer 9

• Yes

Question 10

What are the precautions for using EMLA?

Answer 10

• Do not apply near the eyes, to broken or inflamed skin, or on open wounds
• Do not apply to 200 cm2 or more of skin because it can cause systemic effects in susceptible individuals

Question 11

When applying EMLA (as well as TAC, LAT, and TLE) what precautions does the “applier” need to observe?

Answer 11

• Appliers need to wear gloves to prevent absorption into their fingertips

Question 12

How do you know when EMLA has produced an anesthetic effect?

Answer 12

• When a zone of blanching is observed around the wound

Question 13

*What are the potential complications when using EMLA?

Answer 13

*- May need supplemental infiltration anesthesia

Question 14

**What are “two” types of vapocoolants?

Answer 14

• Ethyl chloride

- Ice

Question 15

What are the medical uses of the “two” vapcoolants?

Answer 15

Ethyl chloride
- Renders the skin numb in preparation for cutting or injection

Ice
- Allows needle insertion or quick incision with minimal to no pain

Question 16

What are some of the respiratory symptoms of anaphylaxis?

Answer 16

• Wheezing
• Coughing
• Dyspnea
• Sensation of chest constriction

Question 17

What are some of the cardiac symptoms of anaphylaxis?

Answer 17

• Hypotension
• Tachycardia
• Syncope
• Cardiac arrest

Question 18

What are some of the GI symptoms of anaphylaxis?

Answer 18

• Nausea
• Vomiting
• Diarrhea
• Abdominal cramping

Question 19

What are the cutaneous symptoms that may occur in anaphylaxis?

Answer 19

• Urticaria (hives, wheals)
• Pruritus
• Warmth and redness

Question 20

What are the differences between immediate onset and slow onset anaphylaxis?

Answer 20

Immediate onset
- Symptoms within minutes of exposure

Slow (delayed) onset
- Symptoms appear over a period ranging from 15 minutes to several hours

Question 21

What are the likely early warning signs of anaphylaxis?

Answer 21

• Sensations of warmth or flushing
• Itching
• Lightheadedness
• Sudden fatigue
• Sense of “something not being right”

Question 22

What is the protocol for treating early onset anaphylaxis?

Answer 22

• Stop treatment
• Call 911
• Administer epinephrine HCl 1:1000, 0.3 - 0.6 cc SubQ or IM
  > Begin with lower dosage and repeat every 15-30 minutes as necessary
  > Lower dose is less likely to cause symptoms of toxicity (hypertension, chest pain, excessive tachycardia, headache)
• Administer oxygen by mask at 15 L/min
• Administer Benadryl 50mg IM
• Monitor for symptoms of epinephrine toxicity

If needed, until paramedics arrive:

• Maintain open airway
• Continue oxygen
• Initiate CPR as needed
• Repeat epi and benadryl
• Check vitals
• If BP dropping, start IV line

If cardiac arrest
- Give epinephrine 1:10,000 10cc IV, followed by 50mg benadryl IV

• Transport by ambulance to the hospital to be monitored for several hours in the ER and/or admitted and monitored for 24-48 hours

Question 23

What is the protocol for treating late onset anaphylaxis?

Answer 23

• Same protocol as treating early-onset anaphylaxis

- Transport to hospital (either car or ambulance)

Question 24

What are the epinephrine concentrations in Epi Pen and Epi Pen Jr?

Answer 24

• EpiPen administers a single 0.3 mL dose of 1:1000 concentration epinephrine
• EpiPen Jr administers a single 0.15 mL dose of 1:2000 concentration epinephrine

Question 25

What do treatment guidelines dictate for all patients with either early or late onset anaphylaxis?

Answer 25

- Transport to the hospital (by ambulance if immediate onset) to be monitored for several hours in the ER and/or to be hospitalized and monitored for 24-48 hours

Question 26

Do you turn the knob on the oxygen tank clockwise or counterclockwise to open the flow valve?

Answer 26

- Clockwise

Question 27

What oxygen flow rate is generally considered to be safe for use in COPD patients?

Answer 27

- 2 L/min (28%)

Question 28

What are the risks of higher oxygen flow rates for COPD patients?

Answer 28

- For COPD patients, higher than 2 L/min on a long-term basis can lead to a depression of ventilatory drive --> hypercapnea

Question 29

What are three problems that may occur with administration of greater than 60% concentration of oxygen for greater than 24 hours?

Answer 29

- Oxygen toxicity > Symptoms include substernal pain, occasional cough, burning pain on inspiration, and dyspnea - Retrolental fibroplasia (retinal damage) in premature infants (can cause variable degrees of irreversible blindness) - Depression of ventilatory drive

Question 30

What are the "three" functions of a horizontal mattress suture?

Answer 30

- "Retention" or "stay" stitch when closing a wound under tension - Helps approximate and evert wound edges (often better than a vertical mattress), which then allows for easy closure with a simple interrupted or running stitch - Helps provide hemostasis in a bleeding wound

Question 31

What are the risks of a horizontal mattress suture?

Answer 31

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

Question 32

When should you remove a horizontal mattress suture?

Answer 32

Variable removal timing - At the time of surgery when suturing with other stitches is complete - A few days later when the wound has begun to heal - Left in place as a "stay" stitch for a few days to weeks