What are the onset/peak effect, duration, and maximum doses of cocaine and tetracaine?
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)
In what instances do topical anesthetics most likely carry the risk of systemic absorption?
- When applied to denuded skin
- When applied to infants
What are the present-day medical uses of cocaine?
- Primarily used in nasal surgery
- To treat resistant cases of epistaxis
What are two present-day medical uses of tetracaine drops?
- For glaucoma testing
- For removal of corneal foreign bodies
What are the OTC uses for lidocaine gel/ointment?
- Sunburns
- Insect stings or bites
How deep can EMLA penetrate?
- 5 mm deep
How quickly does EMLA work?
- Takes up to a full hour to produce a good effect
What are the common uses of EMLA?
- Relieve pain of venipuncture/injections (esp chronic)
- Superficial minor surgery
- Pretreatment for infiltration anesthesia
- Skin graft harvesting
Can EMLA be safely used on mucus membranes?
- Yes
What are the precautions for using EMLA?
- 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
When applying EMLA (as well as TAC, LAT, and TLE) what precautions does the “applier” need to observe?
- Appliers need to wear gloves to prevent absorption into their fingertips
How do you know when EMLA has produced an anesthetic effect?
- When a zone of blanching is observed around the wound
*What are the potential complications when using EMLA?
*- May need supplemental infiltration anesthesia
**What are “two” types of vapocoolants?
- Ethyl chloride
- Ice
What are the medical uses of the “two” vapcoolants?
Ethyl chloride
- Renders the skin numb in preparation for cutting or injection
Ice
- Allows needle insertion or quick incision with minimal to no pain
What are some of the respiratory symptoms of anaphylaxis?
- Wheezing
- Coughing
- Dyspnea
- Sensation of chest constriction
What are some of the cardiac symptoms of anaphylaxis?
- Hypotension
- Tachycardia
- Syncope
- Cardiac arrest
What are some of the GI symptoms of anaphylaxis?
- Nausea
- Vomiting
- Diarrhea
- Abdominal cramping
What are the cutaneous symptoms that may occur in anaphylaxis?
- Urticaria (hives, wheals)
- Pruritus
- Warmth and redness
What are the differences between immediate onset and slow onset anaphylaxis?
Immediate onset
- Symptoms within minutes of exposure
Slow (delayed) onset
- Symptoms appear over a period ranging from 15 minutes to several hours
What are the likely early warning signs of anaphylaxis?
- Sensations of warmth or flushing
- Itching
- Lightheadedness
- Sudden fatigue
- Sense of “something not being right”
What is the protocol for treating early onset anaphylaxis?
- 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
What is the protocol for treating late onset anaphylaxis?
- Same protocol as treating early-onset anaphylaxis
- Transport to hospital (either car or ambulance)
What are the epinephrine concentrations in Epi Pen and Epi Pen Jr?
- 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
