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localanesthetics analgesics sedation more

sedation fun facts

SINGLE JEOPARDY

Appropriate alternative locale anesthetic for patient with

reported allergy to procaine?

Topic I 100 Question

What is any Amide local anesthetic?

Amides Esters

• Lidocaine• Mepivacaine• Bupivacaine• Prilocaine

• Procaine• Benzocaine• Tetracaine

Topic I 100 AnswerGo To Single

Jeopardy

DOUBLE JEOPARDY

2 local anesthetics which can cause methemoglobinemia

Topic I 200 Question

What are:

Topic I 200 AnswerGo To Single

Jeopardy

Benzocaine and Prilocaine

A one year old boy, 10 kg, has just been bitten by a cockapoo...

Topic I 300 Question

No, of course not, it was a pit bull...

He will require extensive laceration repair. Calculate the

maximum doses of lidocaine 1 % with and without epinephrine?

PRIZE !!

What are:

4.5 cc plain, 7 cc with epi?

% solution = gram/dl ; 0.5% = 5 mg/ml, 1.0 % = 10 mg/ml

• Lidocaine 1%: Max dose 4.5 mg/kg plain, 7 mg/kg with epinephrine

• Mepivacaine 1 %: Max dose 5 mg/kg plain, 7 mg/kg with epinephrine

Topic I 300 AnswerGo To Single

Jeopardy

Topic I 400 Question

While injecting lidocaine to anesthetize a laceration, your

patient complains of her tongue feeling numb. Instead of thinking “crazy patient”, you should prepare for the

following 2 problems:

What are:

CNS Toxicity (seizures, coma)

and

Cardiovascular Toxicity (dysrhythmias, myocardial depression)

Toxicity of local anesthetics• All with dose-dependent CV toxicity via

sodium channel blockade (myocardial depression and dysrhythmias)

• Bupivacaine highest CV toxicity• CNS toxicity • Early sx: lightheadedness, peri-oral

paresthesias, tongue numbness, twitching• Seizures-->anticipate VT

Topic I 400 AnswerGo To Single

Jeopardy

5 ways to decrease the pain of infiltration of local

anesthetics?

Topic I 500 Question

What are:1. Inject slowly2. Buffer with sodium bicarbonate3. Inject through open margins of wound4. Use warm anesthetic5. Use small needle6. Reassure patient/distraction

Topic I 500 AnswerGo To Single

Jeopardy

Safe and appropriate oral analgesic choice for patient

reporting an allergic reaction of vomiting to codeine

Topic II 100 Question

What is:

Anything except codeine

Analgesic Classes• Phenanthrenes: Morphine, Hydromorphone,

Codeine, Hydrocodone, Oxycodone, mixed agonists/antagonists

• Phenylpiperidines: Fentanyl, Meperidine

• Diphenylheptanes: Methadone

Topic II 100 AnswerGo To Single

Jeopardy

Analgesic just removed from US market on 11/19/2010

Topic II 200 Question

PRIZE !!

What is propoxyphene?

Topic II 200 AnswerGo To Single

Jeopardy

(darvon, darvocet)

The correct increasing order of potency for the following ORAL

analgesics

• oxycodone• hydromorphone• codeine• morphine• hydrocodone

Topic II 300 Question

What are:

• codeine 200 mg• hydrocodone 30 mg• morphine 30 mg• oxycodone 20 mg• hydromorphone 7.5 mg

Topic II 300 AnswerGo To Single

Jeopardy

This relative of clonidine has sedative and analgesic properties

and reportedly very little respiratory depression

Topic II 400 Question

PRIZE !!

What is dexmedetomidine?

Topic II 400 AnswerGo To Single

Jeopardy

Leave blank

Topic III 100 Question

Leave blank

Topic III 100 AnswerGo To Single

Jeopardy

ASA physical status classification for patient with

well controlled asthma requiring procedural sedation

Topic III 200 Question

What is II?

Topic III 200 AnswerGo To Single

Jeopardy

Amount of time recommended by ASA to wait before sedation after

patient has drank clear liquids

Topic III 300 Question

What is 2 hours?

ASA guidelines

• 2 hrs for clear liquids• 4 hrs for breast milk• 6 hrs for other milk or a light meal

Topic III 300 AnswerGo To Single

Jeopardy

Medication used for procedural sedation which is associated with

adrenal insufficiency and myoclonus

Topic III 400 Question

What is Etomidate?

Buzz words for:PROPOFOL• No analgesia• Decrease ICP• Hypotension• Anti-emetic• Anti-epileptic• Infection• “propofol syndrome”• ?more resp. depression

ETOMIDATE• No analgesia• Decrease ICP• Hemodynamic

stability• Vomiting• Adrenal insufficiency• Myoclonus

Topic III 400 AnswerGo To Single

Jeopardy

An increasingly popular mixture of two procedural medications has this name and contains this

common ratio of the medications

Topic III 500 Question

What is Ketofol?

• Single-syringe 1:1 mixture of 10 mg/mL ketamine and 10 mg/mL propofol

• Usually requires approximately 1 mg/kg (0.5 mg/kg of each)

• Academic Emergency Medicine 2010; 17:194–201

Topic III 500 AnswerGo To Single

Jeopardy

The reason not to use Ketamine in small children with active

URIs

Topic IV 100 Question

PRIZE !!

What is Laryngospasm?

Topic IV 100 AnswerGo To Single

Jeopardy

The most appropriate induction agent for an 18 yo male brought to ED after a single GSW to the

abdomen with a BP of 70/40 who is not protecting his airway

Topic IV 200 Question

What is Ketamine?(would also accept Midazolam)

Topic IV 200 AnswerGo To Single

Jeopardy

Contraindication to use of Nitrous Oxide

Topic IV 300 Question

PRIZE !!

Topic IV 300 AnswerGo To Single

Jeopardy

What is/are: pneumothorax, SBO, middle ear effusion, balloon tip catheter use? Also

head injuries, psych, intoxication

Patient responding to verbal/light touch with adequate spontaneous ventilation

after etomidate sedation is at this sedation level

Topic IV 400 Question

What is Moderate Sedation?

1. Anxiolysis/Minimal Sedation2. Moderate Sedation3. Deep Sedation4. General Anesthesia

Topic IV 400 AnswerGo To Single

Jeopardy

Three requirements prior to the safe discharge of a patient from the ED after procedural sedation

Topic IV 500 Question

What are:

1. Stable Vital Signs2. No respiratory distress3. Has ride home with responsible adult4. No significant N/V, able to take po5. Awake, at neuro baseline, ambulatory,

following instructions

Topic IV 500 AnswerGo To Single

Jeopardy

Alternative method of delivery for Fentanyl besides IV and Transdermal

and Intranasal

Topic V 100 Question

What is Inhaled?

• In Australian study of children with long bone fractures, 1 mic/kg inhaled Fentanyl similar analgesia to 0.2 mg/kg IM morphine

Topic V 100 AnswerGo To Single

Jeopardy

These two drugs are used in the treatment of Complex Regional Pain

Type I (reflex sympathetic dystrophy)

Topic V 200 Question

What are corticosteroids and calcitonin?

Complex Regional Pain I/II

• Type I (RSD), is due to prolonged immobilization or disuse

• Type II (causalgia) from peripheral nerve injury

• Both types with same presentation early: burning pain, edema, warmth, local sweating

• Tx both with steroids, Type I also with calcitonin

Topic V 200 AnswerGo To Single

Jeopardy

What the abbreviation EMLA stands for

Topic V 300 Question

PRIZE !!

What is: What is: Eutectic Mixture of Eutectic Mixture of Local AnestheticsLocal Anesthetics

(prilocaine and lidocaine)

• TAC (tetracaine, adrenaline, cocaine 11.8%)• LET (Lidocaine, Epi 1:1000, Tetracaine)• EMLA (Lidocaine + Prilocaine), occlusion• ELA-Max/LMX (Liposomal Lidocaine), no

occlusion

Topic V 300 AnswerGo To Single

Jeopardy

This high potency ultra-short acting opioid is on the horizon as

a sedative/analgesic

Topic V 400 Question

Topic V 400 AnswerGo To Single

Jeopardy

What is remifentanil?

FINAL JEOPARDY

Analgesia

Ketamine can be used in this dosing regimen as a sub-dissociative drip for

pain control (recently discussed on EM-RAP for trauma patients).

FINAL JEOPARDY

What is 0.3 mg/kg IV bolus then drip of 0.3 mg/kg/hour

IV?

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