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SPM 200 Clinical Skills Lab 4

SPM 200 Clinical Skills Lab 4. Local Anesthesia / Digital Block Daryl P. Lofaso, M.Ed, RRT. 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.

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SPM 200 Clinical Skills Lab 4

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  1. SPM 200 Clinical Skills Lab 4 Local Anesthesia / Digital Block Daryl P. Lofaso, M.Ed, RRT

  2. Anatomy of Skin

  3. Arteries of the Hand • Each hand has 4 digital arteries. • Common Digital Arteries • Dorsal Metacarpal Arteries • Palmar Metacarpal Arteries • Proper Digital Arteries

  4. Nerves of the Hand Digital nerves run down the medial and lateral sides of each digit.

  5. 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)

  6. Risks to You: Hepatitis B, C & HIV • Risk after Needle Stick Exposure • Hepatitis B: 6-30% • Hepatitis C: 3 – 10% • HIV: 0.3%

  7. 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)

  8. Management of Exposure • Report to Employee Health or Emergency Department (LSU Interim Hospital Emergency Room) • Counseling will be provided regarding the need for post exposure prophylaxis (see CDC recommendations)

  9. Indications Digital Block • Excellent anesthesia (dorsal and volar) • Repair of Lacerations beyond Metacarpal • Incisions and Abscesses and Paronychia • Nail removal

  10. ContraindicationsDigitalBlock • Long procedure – short acting • Multiple injuries • Patient allergies

  11. 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

  12. 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

  13. 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

  14. 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

  15. Warning Signs: Systemic Toxicity • Tinnitus, numbness of tongue, lightheadedness, drowsiness • Visual disturbances • Muscle twitching, convulsions, coma, apnea

  16. Digital Block Injection Technique

  17. Patient Injection Technique

  18. Hints to Minimize Patient’s Pain • Small Needle • Inject Anesthetic Slowly • Add Sodium Bicarbonate – basic solutions decrease burn • Warm Solution

  19. 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

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