Local Anesthetics and Wound Healing Quiz
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Questions and Answers

What is the maximum dose of lidocaine with epinephrine that can be administered to an adult?

  • 300 mg
  • 500 mg (correct)
  • 400 mg
  • 200 mg

Which local anesthetic has the longest duration of action when used alone?

  • Lidocaine
  • Bupivacaine (correct)
  • Procaine
  • Mepivacaine

A physician needs to perform a minor surgery with an expected duration of 3 hours. Which local anesthetic with epinephrine would be the MOST appropriate choice?

  • Bupivacaine
  • Lidocaine (correct)
  • Mepivacaine
  • Procaine

Which of the following best describes the onset of action of Bupivacaine?

<p>5 minutes (D)</p> Signup and view all the answers

Why are ester injectables used less frequently than amide injectables?

<p>Higher risk of allergic reactions (C)</p> Signup and view all the answers

What is the primary purpose of wet-to-dry dressings?

<p>To clean and debride wounds with necrotic debris. (D)</p> Signup and view all the answers

Which phase of wound healing involves the migration of myofibroblasts into the wound?

<p>Proliferation phase (C)</p> Signup and view all the answers

Which of the following local anesthetics is commonly used in a topical form for skin and mucous membranes?

<p>Benzocaine (B)</p> Signup and view all the answers

During which phase of wound healing do macrophages remove necrotic tissue?

<p>Inflammation (A)</p> Signup and view all the answers

What concentration of lidocaine is typically used for children?

<p>0.25-0.50% (B)</p> Signup and view all the answers

How long before removal should dressings for open wounds be timed?

<p>48 hours (C)</p> Signup and view all the answers

Which of the following situations would warrant the use of Procaine or Tetracaine?

<p>Ophthalmological Procedures (D)</p> Signup and view all the answers

Why should caution be exercised when operating on lower extremities of patients with Diabetes Mellitus?

<p>Higher risk of post-operative wound infections and poor wound healing. (A)</p> Signup and view all the answers

In the context of potential interference with wound closure, what condition does jaundice indicate?

<p>Liver dysfunction (C)</p> Signup and view all the answers

What is the primary concern when operating in areas with superficial vasculature and nerves?

<p>High propensity for injury (C)</p> Signup and view all the answers

Why is it recommended to delay surgery for 7-10 days when a patient is taking aspirin?

<p>To clear the effects on platelet aggregation. (B)</p> Signup and view all the answers

What is the primary function of chemical mediators released from injured tissue during the coagulation phase?

<p>To induce vasoconstriction, fibrin formation, and platelet aggregation for hemostasis. (D)</p> Signup and view all the answers

What is a contraindication for performing cryosurgery?

<p>High levels of cryoglobulins. (C)</p> Signup and view all the answers

During what phase of wound healing does the scar tissue attain up to 90% strength of the original tissue?

<p>Wound remodeling phase (A)</p> Signup and view all the answers

What is the primary risk of operating on areas with impaired blood circulation?

<p>Necrosis of tissues (B)</p> Signup and view all the answers

Which deficiency has the greatest effect on interfering with wound closure?

<p>Protein (D)</p> Signup and view all the answers

Why should flammable agents like alcohol be avoided when using electrocautery or hyfrecation?

<p>They pose a fire hazard. (D)</p> Signup and view all the answers

What could be a consequence of excessive suture tension in a surgical wound?

<p>Ischemia of the skin edges. (B)</p> Signup and view all the answers

When is toe-nail removal contraindicated?

<p>Presence of paronychia. (A)</p> Signup and view all the answers

During a digital nerve block procedure, after redirecting the needle towards the palmar nerve, where should the injection be administered?

<p>Distal to the MCP/MTP joint (B)</p> Signup and view all the answers

Which systemic adverse effect is NOT associated with anesthetic overdose or intravenous administration?

<p>Hypertension (C)</p> Signup and view all the answers

Why is epinephrine added to local anesthetics?

<p>To induce vasoconstriction, decrease anesthetic's toxic effects, and increase the duration of anesthesia. (B)</p> Signup and view all the answers

Which of the following is a contraindication for using epinephrine in conjunction with a local anesthetic?

<p>Areas with poor circulation, such as fingers and toes (B)</p> Signup and view all the answers

What concentration of epinephrine should be added to 10 mL of anesthetic?

<p>0.1 mg of 1:1000 epinephrine (A)</p> Signup and view all the answers

What is TRUE regarding cryosurgery using liquid nitrogen?

<p>The frozen margin should extend 1-2 mm beyond the lesion’s visible border. (A)</p> Signup and view all the answers

During cryosurgery, when using a cotton tip applicator to apply liquid nitrogen, what is the next step after applying the liquid nitrogen onto the lesion?

<p>Allow the tissue to thaw before repeating applications. (B)</p> Signup and view all the answers

For which type of lesion are cryoprobes frequently used in cryosurgery?

<p>Small facial lesions (D)</p> Signup and view all the answers

What is the primary characteristic of an open drain?

<p>It is not sealed, allowing potential access for bacteria. (C)</p> Signup and view all the answers

Generally, when should dressings be removed post-operatively?

<p>After 48 hours, unless otherwise indicated. (A)</p> Signup and view all the answers

Which suture size represents the thickest diameter?

<p>O (C)</p> Signup and view all the answers

For a patient with delayed healing due to corticosteroid usage, when should sutures typically be removed?

<p>Between 14-21 days to allow for adequate wound closure. (D)</p> Signup and view all the answers

What suture size is typically used for superficial non-absorbable sutures on the face?

<p>6-O (B)</p> Signup and view all the answers

Post-operatively, a patient exhibits angioedema, urticaria, and hypotension. What immediate treatment should be initiated?

<p>Place the patient in shock position and administer steroids, antihistamines, fluids, and oxygen. (D)</p> Signup and view all the answers

What is the primary treatment for 'dog ears' that develop post-operatively?

<p>Removing the sutures, excising the dog ears, and re-suturing the wound. (B)</p> Signup and view all the answers

When should sutures be removed from the ear or eyelid?

<p>14 days (C)</p> Signup and view all the answers

Which degree of hemorrhoids is appropriately treated with band & ligation?

<p>1st degree: bleeding on defecation, no prolapse (C)</p> Signup and view all the answers

A patient presents with a purulent infection at the distal pad of their finger. Which of the following is the most appropriate procedure?

<p>Incision &amp; drainage (B)</p> Signup and view all the answers

What is the recommended procedure for a keratoacanthoma?

<p>Excision biopsy (B)</p> Signup and view all the answers

What is the etiology of Lichen Planus?

<p>Autoimmune-related (B)</p> Signup and view all the answers

Which of the following best describes a lipoma?

<p>A benign growth of adipose tissue (B)</p> Signup and view all the answers

A patient has milia on their face. Which of the following is the most appropriate treatment option?

<p>Fine-needle extraction (D)</p> Signup and view all the answers

Which of the following is the most appropriate treatment for molluscum contagiosum?

<p>Cryosurgery (C)</p> Signup and view all the answers

What is the recommended procedure for a Nevi?

<p>Excision biopsy if it does not meet an abnormal ABCDE criterion (A)</p> Signup and view all the answers

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Flashcards

Wet-to-Dry Dressing

A type of wound dressing used for wounds with necrotic debris. It involves applying a moist dressing that is removed after a period of time, typically 48 hours, to remove debris and promote healing.

Wet-to-Wet Dressing

A dressing that keeps the wound moist, promoting epithelialization and wound closure. It is typically applied after a wet-to-dry dressing.

Coagulation Phase

The first stage of wound healing, where blood clots form to stop bleeding. This involves vasoconstriction, fibrin formation, and platelet aggregation.

Inflammation Phase

This phase is characterized by inflammation, where blood vessels dilate, and healing mediators accumulate in the wound. This results in redness and swelling.

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Proliferation Phase

The third phase of wound healing, where fibroblasts produce collagen fibers to strengthen the wound. This stage also involves wound contraction.

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Remodeling Phase

The final stage of wound healing where the scar tissue remodels and gains strength. This phase can last for years.

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Interference with Wound Closure

A condition where the body is unable to adequately heal due to factors such as malnutrition, diabetes, medications, or smoking. This can interfere with normal wound healing.

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Diabetes

A medical condition that can interfere with wound healing, particularly due to impaired blood sugar control.

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Minor surgery in lower extremities

Surgical procedures performed in the lower extremities, such as the legs and feet, should be approached with caution in individuals with diabetes or poor circulation due to an increased risk of wound infections and delayed healing.

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Areas with superficial vasculature and nerves

Areas like the face, groin, and neck are especially sensitive because of their proximity to important blood vessels and nerves. Minor surgery in these areas requires meticulous attention to detail to avoid damaging these structures.

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Corticosteroids and surgery

People who take corticosteroids, often prescribed to manage autoimmune conditions, have a higher risk of developing infections after surgery. This is because these medications suppress the immune system.

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Anticoagulants and surgery

Patients taking blood thinners (anticoagulants or antiplatelets) are at an increased risk of bleeding during and after surgery. These medications prevent blood clots and may prolong bleeding time.

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Aspirin and surgery

Aspirin, a common over-the-counter medication, impacts platelet aggregation, which is essential for blood clotting. It's recommended to stop aspirin 7-10 days before surgery to allow platelet function to return to normal.

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Bleeding disorders and surgery

People with bleeding disorders, such as hemophilia, or a history of excessive bleeding, are at a higher risk of complications during surgery. These conditions affect the body's ability to clot blood properly.

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Cryosurgery contraindications

Cryosurgery, a procedure that uses extreme cold to destroy tissue, is contraindicated in patients with conditions like cold urticaria, Raynaud's disease, and cryoglobulinemia. These conditions involve abnormal reactions to cold.

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Electrocautery and Hyfrecation precautions

Electrocautery and Hyfrecation, procedures that use heat to cauterize tissue, require caution in patients with metallic implants, IUDs, or metal dentures. The heat can potentially cause burns or damage to these devices.

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What is Lidocaine?

Lidocaine is a common local anesthetic often used for dental procedures. Its concentration typically ranges from 0.5% to 1% for adults and 0.25% to 0.5% for children. It works by blocking nerve impulses, leading to numbness in the targeted area.

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What are the maximum doses of Lidocaine?

The maximum dose of Lidocaine without epinephrine is 300mg, while the maximum dose with epinephrine is 500mg. Epinephrine helps prolong the numbing effect, and the ratio used is typically 1:100,000 or 1:200,000.

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What is Mepivacaine?

Mepivacaine is another common local anesthetic with similar applications to Lidocaine. However, Mepivacaine has a slightly longer onset time and duration than Lidocaine.

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What is Bupivacaine?

Bupivacaine, also known as Marcaine, is a long-lasting amide anesthetic used for surgeries requiring extended pain relief. It is frequently used in dental procedures, spinal procedures, epidurals, and caudal blocks.

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What are ester anesthetics?

Ester anesthetics, while less commonly used now, are known for their faster onset and shorter duration compared to amides. They are also considered to have a higher risk of allergic reactions.

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What is Procaine?

Procaine is a type of ester anesthetic that is typically used for ophthalmological procedures, such as removing foreign objects from the eye.

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What is Tetracaine?

Tetracaine is another ester anesthetic commonly used in ophthalmology. It is often combined with Epinephrine and Cocaine to create a topical anesthetic solution called TAC, which requires careful handling due to its controlled substance status.

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What is Benzocaine?

Benzocaine is an over-the-counter topical anesthetic used for pain relief on skin and mucous membranes. It is available in various forms like sprays, creams, and gels.

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Nerve block

Injecting anesthetic around a nerve to block its function.

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Local infiltration

Injecting anesthetic into the skin to numb a localized area.

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Epinephrine

An anesthetic agent often added to local anesthetics to reduce blood flow and prolong anesthetic effect.

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Systemic toxicity

A complication of nerve block caused by accidentally injecting anesthetic into a blood vessel.

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Vasovagal syncope

A sudden drop in blood pressure due to a decrease in heart rate and blood flow.

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Allergic reaction

A reaction triggered by an anesthetic agent causing hives, swelling, and breathing difficulties.

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Cryosurgery

A technique that uses liquid nitrogen to freeze and destroy tissue.

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Cryoprobe

A specialized probe used in cryosurgery to deliver liquid nitrogen to the target area.

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Open Drain

A type of drain that is open at both ends, allowing for passive drainage of fluid. It is not sealed, which means bacteria and medical instruments can access the draining area.

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Penrose Drain

A type of drain that is used to passively drain fluid after an incision and drainage procedure.

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Suture Removal

Sutures are generally removed after 48 hours.

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Suture Sizes

The largest suture size is designated as "O" (not "zero"), while the smallest size is 10-O.

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Anaphylaxis

A serious allergic reaction that can occur following surgery or medication administration, causing swelling, rash, low blood pressure, and difficulty breathing.

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Dog Ears

A complication where the skin puckers due to excessive tightening of the wound edges during suturing.

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Edema

A common complication after surgery, it involves excessive fluid accumulation in the body tissues.

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Hernia

An abnormal protrusion of an organ or tissue through a weak area in the abdominal wall.

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Hemorrhoids

Swollen veins in the anal canal, causing pain during bowel movements and potentially bright red bleeding if ruptured.

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Felon

A pus-filled infection at the tip of a finger.

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Keratoacanthoma

A rapidly growing, dome-shaped skin lesion with a keratin cap.

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Lipoma

A harmless, benign growth made of fat tissue.

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Milia

Tiny, white bumps on the face, caused by trapped keratin.

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Lichen Planus

A small, flat, pink rash, often thought to be caused by autoimmune disorders.

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Pyogenic Granuloma

A benign growth on the skin or lining of the body, with prominent blood vessels, causing redness and possible bleeding.

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Paronychia

An infection at the base of a fingernail.

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Study Notes

Pre-Operative Precautions

  • General considerations

    • Patients taking corticosteroids (immunosuppressants) are at higher risk of post-operative infection
    • Patients taking anticoagulants or antiplatelets (blood thinners) may be at higher risk of hemorrhaging. Aspirin should be discontinued 7-10 days before surgery to reduce effects on platelet aggregation
    • Patients with bleeding disorders or coagulopathies
    • Patients with high levels of cryoglobulins, cold urticaria, or Raynaud's disease should not undergo surgery on areas with impaired circulation

  • Cryosurgery

    • Avoid areas at risk for hair loss
    • Patients with significant risk factors like high levels of cryoglobulins, cold urticaria, or Raynaud's disease should not undergo surgery on those areas

  • Electrocautery & Hyfrecation -Avoid flammable agents for disinfection -Caution when working with patients with metal implants, IUDs, metal dentures, or prosthetics, and patients should remove all jewelry

  • Suturing

    • Avoid suture tension during wound closure, as it may cause skin edge ischemia. -Insert the suturing needle perpendicular (90°) to the skin plane to evert skin edges
    • Do not suture wounds with contamination (ex. puncture or bite wounds, wounds with discharge)

Wound Care

  • Before wound closure
    • Hemostasis is essential prior to any cleaning or wound closure attempt
  • During wound closure
    • Primary closure: used for wounds with minimal contamination, involves approximating and closing the skin edges (suturing)
    • Secondary closure: used for wounds with higher risk of contamination or infection, the wound is left open, allowing healing by epithelialization and wound contraction
    • Delayed primary closure: heavily contaminated wounds that no longer have residual contamination may be closed directly through primary closure methods.
  • After wound closure
    • Dressings -Sutured wounds require dressings to absorb drainage and provide moisture support for epithelialization -Open wounds require dressings to maintain moisture for healing process
  • Interference with wound closure -Factors influencing wound healing such as malnutrition, diabetes, jaundice, uremia, medications or chemotherapy

Equipment

  • Biopsy punch
    • Instrument used for taking tissue samples from a lesion to study it
    • Diameter selected to allow sampling of area surrounding lesion
  • Cryogens -Liquid nitrogen (most common, rapid and deep destruction) -Carbon dioxide (dry ice, poor tissue destruction)
  • Curette
    • Scraping tool used for superficial and partial-thickness tissue lesions
  • Electrocautery -Electrical current tool used to destroy tissues and coagulate blood vessels
  • Chemical cautery
    • Chemical agents that destroy tissues (ex. phenol, silver nitrate, salicylic acid, etc)

Operative Procedures

  • Anesthesia
  • Selection and use of different anesthetic types
  • Monitoring adverse effects such as allergic reaction, cardiovascular reactions, central nervous system reactions, vasovagal reactions
  • Other operative procedures
  • Detailed steps for specific procedures such as those involving different lesions

Post-Operative Procedures

  • Dressings -Purpose: - Absorption of exudates to prevent fluid loss -Aiding in debridement of necrotic tissues -Providing hemostasis (stopping bleeding) -Pain relief -Wound protection and support
  • Removal -Usually removed after 48 hours or as clinically warranted.

Post-Operative Complications

  • Detailed descriptions of various complications from surgical procedures, categorized by symptoms.

Operative Procedures by Lesion

  • Descriptions of procedures to treat different kinds of lesions. Each lesion type has a distinct description and suggested treatment method.

Injecting an Anesthetic

  • Local techniques (direct infiltration, field block) detailed explanations of methods
  • Regional techniques (nerve blocks)

Adverse Effects to Monitor

  • Potential adverse effects patients may experience from surgical procedure

Adding Epinephrine

  • Rationale for use, indications, and/or contraindications

Step-by-Step Instructions for Various Procedures

  • Explicit guidance for each of the types of procedures mentioned in the text (excision, removal, cryo, electrosurgery, etc).

Excision and Removal

  • Step by step procedure to remove a lesion.
  • Specifics of how to prepare, such as using a clean field or disinfectant

Incision and Drainage

  • Step-by-step instruction to perform this procedure, using sterile procedures and appropriate tools

Suturing

  • Description of various suturing techniques (interrupted, buried, horizontal mattress, vertical mattress, running/continuous)
  • Advantages and disadvantages of each technique
  • Specifics for each suture type (synthetic, natural)
  • Conditions where sutures (or adhesives) are contraindicated.

Alternatives to Suturing

  • Description of use of adhesives (ex. cyanoacrylate glue) as alternatives to sutures
  • Types and functions of adhesives in surgical repair
  • Advantages and disadvantages of using adhesives over sutures.

Additional information (Page 19)

  • Information on post-operative complications, various lesions (by type), and further detailed information on operative procedures

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