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QUIZ17thJune2020(answersbelow)
1. Whatarethesignsoflocalanaesthetictoxicity?
2. Whatisthemanagementoflocalanaesthetictoxicity?
3. Howdoyouusetheslitlamptolookforcellsintheanteriorchamber?
4. Whereontheslitlampisthecobaltbluefilterforthefluorosceinexam?
5. DescribeandinterpretthefollowingECG.
QUIZanswers17thJune2020
1. Whatarethesignsoflocalanaesthetictoxicity?
Earliestsymptomsareneurologicalandincludetinnitus,dizziness,anxiety,confusionandperioralnumbness.More severe signs are seizures, coma, bradycardia, hypotension, and arrhythmiasincludingVFandasystoleandrespiratorydepression
2. Whatisthemanagementoflocalanaesthetictoxicity?
Earlyrecognitionofsymptomsandprompttreatmentisimportant.Thedevelopmentof even mild symptoms during or shortly after local anaesthetic administrationmandatescardiovascularmonitoringinresuscitationarea.
Toxicity is theresultofsodiumchannelblockade,somanagement isverysimilartoothersodiumchannelblockingagents,liketricyclicantidepressants.Specificinterventionsinclude:
BicarbonateforCVStoxicityEarlyintubationtopreventacidosisminimisesriskofcardiacarrestSeizuresaretreatedwithbenzodiazepinesLipidemulsioninsevereCVStoxicityorrefractorycardiacarrest
ThethresholdforadministeringintralipidiscontroversialIntralipid20%500mLbottlesarekeptintheEDdrugcupboard
Give100mLstatandthenrunremaining400mLover20minutes
3. Howdoyouusetheslitlamptolookforcellsintheanteriorchamber?
Shorten the slit light beamandwiden it slightly. Angle the beam so that the lightpathhitsthecorneaononesideofwhereyouseethepupil,andhitstheirisontheotherside,inorderthattheanteriorchamberisseenagainsttheblackbackgroundofthepupil.Focusonthecornea,andthenlengthenthefocustotheiris.Slowlyshortenthefocustothecorneaonceagain,sothatthefocuspointrunsthroughtheanteriorchamber,potentiallyfocusingoncellsintheaqueoushumor.Cellscanbeseenasmovingwhitedots.Thecellsmaymoveupwardsatthebackoftheanteriorchamberanddownwardinthefront,duetotheconvectioncurrentsetupbytheincreasedwarmthatthebackoftheeye.
Flareisthesmokyorcloudyappearanceofthebeamoflightintheanteriorchamber.Thisisduetoincreasedprotein,alsocausedbyinflammation.
4. Whereontheslitlampisthecobaltbluefilterforthefluoresceinexam?
5. DescribeandinterpretthefollowingECG.Rate Bradycardic25/min Exceptbeats#4and#6whichoccurearlyat55/minPwave IcanonlyseeonePwavebetween#5and#6PRinterval IfthatPwaveisconductedto#6,thePRintervalisprolonged0.28secQRS Narrow Normalaxis QwavesV1-2Twaves PeakedV3-6 TWIinaVLQTc Notprolonged
è Junctionalbradycardia PossibleconductedPwavebutwith1stdegreeHB PeakedTwaves
è ThispatienthadK+6.8mmol/L