Pain Management Quiz 1 SG

1.Needle IS in a vessel, but negative pressure has sucked the opposing vessel wall against the lumen; Malamedand others teach to rotate the syringe and aspirate in two planes to avoid false negatives.
ØAs an added safety factor, we will re-aspirate after about ½ stopper full has been administered
ØThis is another reason why we wait 3 seconds

False Negative

ØAs an added safety factor, we will re-aspirate after about _______ stopper full has been administered½Handling a Positive Aspiration: If a lot of blood entersØWithdraw and change cartridgeHandling a Positive Aspiration: If just tiny little bit BLOOD entersØDecide if you need to change the cartridge by your ability to recognize an another positive aspiration ØIf too much blood, you won't be able to see more enter if you happen to get another positive aspirationtypes of positive aspirations: 1.bright red blood, enters rapidly, can fill carpule: remove syringe, place a new anesthetic cartridge, and re-injectArterialtypes of positive aspirations: 1.darker red, sometimes almost brown. Enters carpule slowly; sometimes stays localized in the hub area and difficult to see. Make decision on whether to reposition and try again or replace cartridge based on amount (could you see another positive with 100% accuracy?)VenousInjecting directly into a vessel can have these potential affects: (2)1.Ineffective anesthesia (rapidly carried through the body and cannot take effect locally) 2.Local Anesthesia or Vasoconstrictor Toxic Reaction slide 73 basic injection technique•a process of rapid nerve impulse conduction in myelinated nervesSaltatory conduction:•Due to the insular properties of myelin, the electrical impulse's energy is shielded and can conduct along the axon much faster, jumping from Node to Node (of Ranvier), sometimes even skipping someSaltatory conduction:Nerve Size and Saltatory Conduction•As nerve thickness [size] increases, myelin thickness increases •Distance between nodes increases •Conduction even faster!Pain Transmitting Nerve Fibers? (2)A delta and C•Large, lightly myelinated nerve fibers; fast conduction, transmit sharp, electric, shocking pain sensationsA delta nerve fiber•Small, unmyelinated nerves with SLOW conduction; transmit dull, achy, throbbing pain sensationsC nerve fiberIndividual fibers separated from one another by_____•endoneuriumPerineurium-bundles a group of axons into________•fasciculi: (the bundle of axons)Inner layer of perineurium is called its•perilemmaThe loose connective tissue layer that surrounds all of the fasiculi is called theepineurium•Located around the fascicule perimeter; •Innervate areas in close proximity •Receive anesthetic solution first•Mantle bundles:•Located on interior region of fascicule; •Innervate structures in a more peripheral location •Receive anesthetic later•Core bundles:•Receive anesthetic solution first? •Receive anesthetic later-mantle bundles -core bundles•IA injection- _____________ innervate molars, so easier to numb, anteriors are harder to numb •Molars take effect sooner, lose anesthetic sooner •If molars are numb but anterior teeth/lip/chin aren't, have only reached mantle bundlesmantle bundlesIf core and mantle bundles have both lost LA, they may not react to LA•(tachyphylaxis)•Electrical process •Depend on ion changes along nerve membranesNerve ConductionStages in Nerve Conduction? (5)1.Resting state 2.Slow depolarization 3.Firing threshold hit 4.Rapid depolarization •Reversal of polarity 5.Repolarization-70 mVresting potiential•of -70 mV across membrane because of differing concentrations of ions on either side •Interior is negatively charged compared to exterior of the nerveResting potential-internal potential becomes slightly less negativeslow depolarization-Once falling potential reaches a critical level (threshold potential, firing threshold) it results in extremelyrapid depolarization-causes the reversal of electrical potentialaction potential-This causes the reversal of the electrical potential (interior becomes positive, +40 mV) and an electrical potential gradually becomes more negative inside the nerve until -70 mV is achievedRepolarization•A nerve is in the resting state when it receives no stimulation •Potassium (K+) remains inside cell •Chloride is outside (Cl-), •Sodium mostly outside, is slowly migrating inward (Na+) -70Resting Potential / State-70mV charge is held largely by ____ and ____K+ and Na+ ions•Intracellular (axoplasm) is negatively charged at ______ & _______ (_____)-60 to -90 mV (average -70 mV )__________ participate with the Na+ ions to maintain the resting membrane potential•Chloride ions•Ion channels are "gated" by __________at specific receptor sitesCa+2 ions

Pain Management Quiz 1 SG

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