Posted: 5/9/2012 7:32:36 PM EDT
|
In a SHTF situation where professional medical care could be weeks or months away, and when all other methods of wound closure have been tried and failed so that stitches are the only option, will a 2% lidocaine solution work well enough as an anesthetic?
Any by well enough, I mean will it numb the area enough so that the pain is brought down to a tolerable level. |
|
Not sure what 10 0/0 is, but lidocaine is probably the most commonly used medications in ERs today for local anesthetic (I actually use bupivicaine, but I am in the minority). Usually 1% (or even 0.5%) is used because the toxic dose of lidocaine is around 4 mg/kg (when used without epi).
The down side to 2% is the increased risk of toxicity without a gain in efficacy. For the nonexistent theoretical 70 kg man, 30 ml of 1% lido is around the toxic dose. This means 15 ml of 2% would be around the toxic dose, so it would be fairly easy to cause seizures with a decent sized wound. Also, not sure what you mean by "all other methods of wound closure tried and failed". Remember that if you are going to suture you should do it early (primary closure) or several days out when you are sure there is no evicence of infection (delayed primary closure). |
|
Quoted:
Not sure what 10 0/0 is, but lidocaine is probably the most commonly used medications in ERs today for local anesthetic (I actually use bupivicaine, but I am in the minority). Usually 1% (or even 0.5%) is used because the toxic dose of lidocaine is around 4 mg/kg (when used without epi). The down side to 2% is the increased risk of toxicity without a gain in efficacy. For the nonexistent theoretical 70 kg man, 30 ml of 1% lido is around the toxic dose. This means 15 ml of 2% would be around the toxic dose, so it would be fairly easy to cause seizures with a decent sized wound. Also, not sure what you mean by "all other methods of wound closure tried and failed". Remember that if you are going to suture you should do it early (primary closure) or several days out when you are sure there is no evicence of infection (delayed primary closure). I think he meant 10%. Thank you for the info. More for me to look into. I threw in the "all other methods of wound closure tried and failed" statement because I look at stitches as a last effort in a SHTF situation due to the risk of infection and doing it wrong which could tear skin and make the wound worst. I would try butterfly closures, pressure dressings, etc to close up the wound before I went to put in stitches because I am not a medically trained person and I don't have the experience to know when to skip the above and go straight to stitches (with the exception of an obviously deep wound). Trying to close the wound using bandages and tape, then making the decision to go with stitches would be done on a case by case basis depending on where the wound was, if we could immobilize it, etc. But this is all new to me so I am learning what I can when I can prior to needing the information. |
|
I use 2% or 1% in my office all the time. If I'm buffering it with bicarb (eliminates the burn), then I'll reach for 2% because I dilute it 3:1 Lido to Bicarb.
Bupivicaine works well, but it's more expensive and lasts longer (a lot longer) than I need/want it to. Either 1% or 2% is fine for sutures etc. ETA: last time I went in for a kidney stone they used preserved sterile saline for anesthetic for the IV. Didn't feel a dang thing. |
|
Quoted:
Are you better off with straight lidocaine or lidocaine with epi? Or both? Some people are sensitive to epinephrine and it can cause racing heartbeat and elevation of blood pressure. Straight lidocaine works fine but has a shorter duration of action, that's all. In most cases where local anesthetic would be used, short duration is fine. Dental usage is generally 2% with epi 1:100,000 because procedures can take up to an hour. For sutures in a pinch, ice should help some. |
|
Quoted:
Are you better off with straight lidocaine or lidocaine with epi? Depends what you're suturing. Epi makes the lidocaine last longer, and the wound bleed less when you're stitching it. It may also make the (finger, ear, toe) die and rot off if the area you inject doesn't have a good collateral blood supply. That's less desirable. |
|
For closing wounds, I would use super glue.
SUPER GLUE - "CA glue was in veterinary use for mending bone, hide, and tortoise shell by at least the early 1970s. The inventor of cyanoacrylates, Harry Coover, said in 1966 that a CA spray was used in the Vietnam War to retard bleeding in wounded soldiers until they could be brought to a hospital. Butyl cyanoacrylate has been used medically since the 1970s outside the US, but, due to its potential to irritate the skin, the U.S. Food and Drug Administration did not approve its use as a medical adhesive until 1998 with Dermabond.[10] Research has demonstrated the use of cyanoacrylate in wound closure as being safer and more functional than traditional suturing (stitches).[11] The adhesive has demonstrated superior performance in the time required to close a wound, incidence of infection (suture canals through the skin's epidermal, dermal, and subcutaneous fat layers introduce extra routes of contamination),[11] and final cosmetic appearance.[12][13]" Click here for full Wikipedia article |
|
Quoted:
Ugh I'm allergic to Epi. When I go to the dentist I get lidocaine with no Epi, and root canals suuuuuuuuuck. Glad to know it's so toxic.  You can't be allergic to epinephrine; your adrenal glands produce it. It's also not in the least bit toxic for the same reason. Perhaps you are merely sensitive? |
|
Quoted:
Quoted:
Ugh I'm allergic to Epi. When I go to the dentist I get lidocaine with no Epi, and root canals suuuuuuuuuck. Glad to know it's so toxic. You can't be allergic to epinephrine; your adrenal glands produce it. It's also not in the least bit toxic for the same reason. Perhaps you are merely sensitive? Or perhaps one of.the other inert ingredients. My practice is usually 1%the Lido like most have said. Ill also do 1% with bupivicaine for longer procedures, though typically 1:1. On a side note, Dermabond and super glue are NOT the same. Slight difference in the chemical structure. The other nice thing about DB is that it resists entry into the wound by other microorganisms. |
|
Quoted:
Ugh I'm allergic to Epi. When I go to the dentist I get lidocaine with no Epi, and root canals suuuuuuuuuck. Glad to know it's so toxic. I hear the "I'm allergic to epi" thing quite a bit and they're almost always dentist office stories. I'm not bashing dentists, but that seems to be what dentists tell people when they give them an unintended IV or arterial injection of Local anesthetic w/epi and people get that "I'm dying" feeling from the "rush." You're probably not allergic to epinephrine since that's one of the key drugs that a health care provider would administer to TREAT a serious allergic reaction. 
|
|
Quoted:
Quoted:
Ugh I'm allergic to Epi. When I go to the dentist I get lidocaine with no Epi, and root canals suuuuuuuuuck. Glad to know it's so toxic. You can't be allergic to epinephrine; your adrenal glands produce it. It's also not in the least bit toxic for the same reason. Perhaps you are merely sensitive? Well maybe sensitive is the right word. My BP bottoms out and I have collapsed from it at the dentist's office twice. Without it, no issues. |
|
Quoted:
Quoted:
Ugh I'm allergic to Epi. When I go to the dentist I get lidocaine with no Epi, and root canals suuuuuuuuuck. Glad to know it's so toxic. I hear the "I'm allergic to epi" thing quite a bit and they're almost always dentist office stories. I'm not bashing dentists, but that seems to be what dentists tell people when they give them an unintended IV or arterial injection of Local anesthetic w/epi and people get that "I'm dying" feeling from the "rush." You're probably not allergic to epinephrine since that's one of the key drugs that a health care provider would administer to TREAT a serious allergic reaction. I get the same thing. ALWAYS the dentist's office. They spook patients then the rest of us have to deal with it. |
|
Quoted:
Quoted:
Quoted:
Ugh I'm allergic to Epi. When I go to the dentist I get lidocaine with no Epi, and root canals suuuuuuuuuck. Glad to know it's so toxic. I hear the "I'm allergic to epi" thing quite a bit and they're almost always dentist office stories. I'm not bashing dentists, but that seems to be what dentists tell people when they give them an unintended IV or arterial injection of Local anesthetic w/epi and people get that "I'm dying" feeling from the "rush." You're probably not allergic to epinephrine since that's one of the key drugs that a health care provider would administer to TREAT a serious allergic reaction. I get the same thing. ALWAYS the dentist's office. They spook patients then the rest of us have to deal with it. All I know is with Epi I have problems, without it I don't. 
|
|
Quoted:
Quoted:
Quoted:
Ugh I'm allergic to Epi. When I go to the dentist I get lidocaine with no Epi, and root canals suuuuuuuuuck. Glad to know it's so toxic. I hear the "I'm allergic to epi" thing quite a bit and they're almost always dentist office stories. I'm not bashing dentists, but that seems to be what dentists tell people when they give them an unintended IV or arterial injection of Local anesthetic w/epi and people get that "I'm dying" feeling from the "rush." You're probably not allergic to epinephrine since that's one of the key drugs that a health care provider would administer to TREAT a serious allergic reaction. I get the same thing. ALWAYS the dentist's office. They spook patients then the rest of us have to deal with it. Theres also the "every murmur needs SBE prophylaxis" silliness. |
|
Saying that you are allergic to epi is equivalent to saying that you are allergic to your own saliva, or your own sweat or urine. Epi is the same as adrenaline, which is made in your adrenal glands. It is theoretically possible to be allergic to a preservative in epi, although I have never actually seen or heard of a patient who really has this allergy.
Epi causes flushing, elevated blood pressure, elevated heart rate, nausea, tremors, and a sense of doom (fight or flight response) when it is given IV. This is not an allergic reaction. This is what it is supposed to do, just like adrenaline does when someone is trying to kill you. |
|
Quoted:
Saying that you are allergic to epi is equivalent to saying that you are allergic to your own saliva, or your own sweat or urine. Epi is the same as adrenaline, which is made in your adrenal glands. It is theoretically possible to be allergic to a preservative in epi, although I have never actually seen or heard of a patient who really has this allergy. Epi causes flushing, elevated blood pressure, elevated heart rate, nausea, tremors, and a sense of doom (fight or flight response) when it is given IV. This is not an allergic reaction. This is what it is supposed to do, just like adrenaline does when someone is trying to kill you. So it caused my BP to spike, and then bottom out to the point where I collapsed? Guess that makes sense as it was not an immediate reaction and it happened in the waiting room as I was getting ready to leave after a root canal. |
| Actually, what you probably had was a delayed vasovagal syncope (or near syncope) which was not directly related to the epi at all, but related to the injection itself, or pain from the procedure.. |
|
A true allergy is IgE mediated. Histamine release, hives, vasoconstriction, wheezing, death etc etc.
Google it. Anything else is a 'reaction' and is therefore not a real/true 'allergy'. The difference is truly life and death, or should I say life and panic/discomfort |
|
Quoted:
Quoted:
Saying that you are allergic to epi is equivalent to saying that you are allergic to your own saliva, or your own sweat or urine. Epi is the same as adrenaline, which is made in your adrenal glands. It is theoretically possible to be allergic to a preservative in epi, although I have never actually seen or heard of a patient who really has this allergy. Epi causes flushing, elevated blood pressure, elevated heart rate, nausea, tremors, and a sense of doom (fight or flight response) when it is given IV. This is not an allergic reaction. This is what it is supposed to do, just like adrenaline does when someone is trying to kill you. So it caused my BP to spike, and then bottom out to the point where I collapsed? Guess that makes sense as it was not an immediate reaction and it happened in the waiting room as I was getting ready to leave after a root canal. There are several things that could have caused your "spell." You could have had a vagolytic vagal reaction to pain (very common, IMO it's more common among men). You may have had orthostatic hypotension. Either are more likely than a delayed reaction to epinephrine. I say delayed reaction because the injections of local with epi would typically occur before a root canal, and your reaction didn't occur until the point you were leaving the office. If you had a drug reaction that was severe enough to lower your blood pressure to a point that you were losing consciousness, that reaction would have been followed by a 911 call, and IV start, supplemental oxygen, and probably a trip to a hospital for some steroids, antihistamines, and epinephrine.
|
|
Quoted:
A true allergy is IgE mediated. Histamine release, hives, vasoconstriction, wheezing, death etc etc. Google it. Anything else is a 'reaction' and is therefore not a real/true 'allergy'. The difference is truly life and death, or should I say life and panic/discomfort Where'd you get that factoid? |
|
Not to be too picky, but an allergic reaction causes BRONCHOconstriction, and VASOdilatation.
Also, a vagoLYTIC is something (typically a drug) which OPPOSES the action of the vagus nerve. Atropine is the classic vagolytic. Vagal or vasovagal syncope is mediated BY the vagus nerve. (Since we are being precise here) |
|
Quoted:
Not to be too picky, but an allergic reaction causes BRONCHOconstriction, and VASOdilatation. Also, a vagoLYTIC is something (typically a drug) which OPPOSES the action of the vagus nerve. Atropine is the classic vagolytic. Vagal or vasovagal syncope is mediated BY the vagus nerve. (Since we are being precise here) ayup, you got me. I meant vagal reaction. 
|
If I'm ever made Nurse General (as opposed to Surgeon General) I'd set up public health lever education on what is and what isn't an allergy
For what it's worth, I kind of see using local in SHTF as really only being useful for dental work. If it's a traumatic injury, or god forbid a surgery, yer in way over Local's head anyways. Wound closure / I&D (Irrigation and Debridement or Incision and Drainage) would be in pretty good pain anyways, what's a little more, and with the drainage types, the incision tends to help with pain and you wouldn't use local there anyways (not when there is infection present, wouldn't want errant bugs hijacking outside the wound via the injection tract to the body now, would we). Nitrous was used effectively as was Ether in the good old days, but they were both used by PROFESSIONALS and both have since been found to have their drawbacks / dangers. I work with Anesthesia providers every day and I have to say that they are crazy intelligent folks that have a massive grasp of their drugs and their effects. This topic of SHTF anesthesia has been around before, and I didn't chime in that time. I guess I feel compelled this time. We can arm chair all we want. We can cobble together Field medic kits. We can play warrior. One thing we shouldn't plan on doing is DIY healthcare. No Local anesthetic surgery, no fish antibiotic, and no IVs using turkey baster needles, surgical tubing, salt and bottled water (Shooter Movie referance for those not paying attention). (Rant Off) Sorry jim |
|
Quoted:
If I'm ever made Nurse General (as opposed to Surgeon General) I'd set up public health lever education on what is and what isn't an allergy
For what it's worth, I kind of see using local in SHTF as really only being useful for dental work. If it's a traumatic injury, or god forbid a surgery, yer in way over Local's head anyways. Wound closure / I&D (Irrigation and Debridement or Incision and Drainage) would be in pretty good pain anyways, what's a little more, and with the drainage types, the incision tends to help with pain and you wouldn't use local there anyways (not when there is infection present, wouldn't want errant bugs hijacking outside the wound via the injection tract to the body now, would we). Nitrous was used effectively as was Ether in the good old days, but they were both used by PROFESSIONALS and both have since been found to have their drawbacks / dangers. I work with Anesthesia providers every day and I have to say that they are crazy intelligent folks that have a massive grasp of their drugs and their effects. This topic of SHTF anesthesia has been around before, and I didn't chime in that time. I guess I feel compelled this time. We can arm chair all we want. We can cobble together Field medic kits. We can play warrior. One thing we shouldn't plan on doing is DIY healthcare. No Local anesthetic surgery, no fish antibiotic, and no IVs using turkey baster needles, surgical tubing, salt and bottled water (Shooter Movie referance for those not paying attention). (Rant Off) Sorry jim I hereby nominate you for nurse general.
Seriously there are a lot of "intolerances" that people list as allergies. Morphine makes me loopy, this antibiotic gives me diarrhea, etc, etc. When you claim something as an allergy then you NEVER receive that drug again. Don't completely write off a drug that you may need one day because it gave you diarrhea. My first patient the other day listed succinylcholine as a drug allergy. I thought to myself, "great, the first patient of the day probably has MH in his family history." He had never even heard of MH. When I questioned him about his reaction to succs was he said, "it makes me stop breathing." No shit.  You should've seen the look on his face when I explained to him that was the therapeutic effect of the drug. 
|
|
Quoted:
Quoted:
A true allergy is IgE mediated. Histamine release, hives, vasoconstriction, wheezing, death etc etc. Google it. Anything else is a 'reaction' and is therefore not a real/true 'allergy'. The difference is truly life and death, or should I say life and panic/discomfort Where'd you get that factoid? Maybe technically I should have said atreriolar constriction. Ever hear of "fingers toes penis nose"? Shoot some epi in your dick and tell me if it constricts or dilates..... |
|
Quoted:
Quoted:
Quoted:
A true allergy is IgE mediated. Histamine release, hives, vasoconstriction, wheezing, death etc etc. Google it. Anything else is a 'reaction' and is therefore not a real/true 'allergy'. The difference is truly life and death, or should I say life and panic/discomfort Where'd you get that factoid? Maybe technically I should have said atreriolar constriction. Ever hear of "fingers toes penis nose"? Shoot some epi in your dick and tell me if it constricts or dilates..... The "fingers, toes, noses and hoses" (as I learned it) refers to epi, not to allergic reactions. Allergic reactions cause vasodilatation, epi causes vasoconstriction. That is why hypotension is one of findings which indicates anaphylaxis in each of the three diagnostic criteria. Although I think we have hijacked this thread into oblivion.
And, I think it is phenylephrine, not epi which is recommended for injection into the penis for priapism (actually the corpus cavernosum), if I recall correctly, although I haven't done it in a while. This is because it is a more pure alpha agonist, as opposed to the mixed alpha and beta agonist that epi is. ETA: "I sedate you", it took me a while to figure out your screen name. Very nice. Haven't figured out "eyegun" yet, all I can think of is "Ralphie" and a BB gun. |
|
Quoted:
Quoted:
Quoted:
A true allergy is IgE mediated. Histamine release, hives, vasoconstriction, wheezing, death etc etc. Google it. Anything else is a 'reaction' and is therefore not a real/true 'allergy'. The difference is truly life and death, or should I say life and panic/discomfort Where'd you get that factoid? Maybe technically I should have said atreriolar constriction. Ever hear of "fingers toes penis nose"? Shoot some epi in your dick and tell me if it constricts or dilates..... During anaphylaxis you won't find any vaso or arteriolar constriction, but vasodilation is common. I thought you just mistyped and I was pointing that out to you, that's all. You completely fucking lost me with the "shoot some epi in my dick" comment.  None of where you should and shouldn't administer epi is germane to anaphylaxis.
eta: I was beaten to the punch by juslearnin. Oh well, I'm off to shoot some epi into my dick to see what'll happen.
|
|
ISED8U I will bow to your experience (as I figured out what you do), but from my standpoint as an eye guy, epi has many effects.
Don't shoot that sfuff in your dick you know it (dick) will blanche from vasoconstriction/arteriolarconstriction and it will die off and fall off. No dude can afford that....and as we all know the women of this world wouldn't want that |
|
Quoted:
Quoted:
Quoted:
Saying that you are allergic to epi is equivalent to saying that you are allergic to your own saliva, or your own sweat or urine. Epi is the same as adrenaline, which is made in your adrenal glands. It is theoretically possible to be allergic to a preservative in epi, although I have never actually seen or heard of a patient who really has this allergy. Epi causes flushing, elevated blood pressure, elevated heart rate, nausea, tremors, and a sense of doom (fight or flight response) when it is given IV. This is not an allergic reaction. This is what it is supposed to do, just like adrenaline does when someone is trying to kill you. So it caused my BP to spike, and then bottom out to the point where I collapsed? Guess that makes sense as it was not an immediate reaction and it happened in the waiting room as I was getting ready to leave after a root canal. There are several things that could have caused your "spell." You could have had a vagolytic vagal reaction to pain (very common, IMO it's more common among men). You may have had orthostatic hypotension. Either are more likely than a delayed reaction to epinephrine. I say delayed reaction because the injections of local with epi would typically occur before a root canal, and your reaction didn't occur until the point you were leaving the office. If you had a drug reaction that was severe enough to lower your blood pressure to a point that you were losing consciousness, that reaction would have been followed by a 911 call, and IV start, supplemental oxygen, and probably a trip to a hospital for some steroids, antihistamines, and epinephrine.
It did include a trip to the hospital in the back of a van with O2 and an IV. No idea about the others. I think they were being overly cautious, but that particular dentist said I should never have novacaine again. Imagine the fun of having a tooth subsequently quartered and extracted with only lidocaine to ease the pain. That was excruciating. Well, good to know I'm not allergic like I was told and it was only a reaction. Thanks for the education. 
|
|
Quoted:
Quoted:
Quoted:
Quoted:
Saying that you are allergic to epi is equivalent to saying that you are allergic to your own saliva, or your own sweat or urine. Epi is the same as adrenaline, which is made in your adrenal glands. It is theoretically possible to be allergic to a preservative in epi, although I have never actually seen or heard of a patient who really has this allergy. Epi causes flushing, elevated blood pressure, elevated heart rate, nausea, tremors, and a sense of doom (fight or flight response) when it is given IV. This is not an allergic reaction. This is what it is supposed to do, just like adrenaline does when someone is trying to kill you. So it caused my BP to spike, and then bottom out to the point where I collapsed? Guess that makes sense as it was not an immediate reaction and it happened in the waiting room as I was getting ready to leave after a root canal. There are several things that could have caused your "spell." You could have had a vagolytic vagal reaction to pain (very common, IMO it's more common among men). You may have had orthostatic hypotension. Either are more likely than a delayed reaction to epinephrine. I say delayed reaction because the injections of local with epi would typically occur before a root canal, and your reaction didn't occur until the point you were leaving the office. If you had a drug reaction that was severe enough to lower your blood pressure to a point that you were losing consciousness, that reaction would have been followed by a 911 call, and IV start, supplemental oxygen, and probably a trip to a hospital for some steroids, antihistamines, and epinephrine.
It did include a trip to the hospital in the back of a van with O2 and an IV. No idea about the others. I think they were being overly cautious, but that particular dentist said I should never have novacaine again. Imagine the fun of having a tooth subsequently quartered and extracted with only lidocaine to ease the pain. That was excruciating. Well, good to know I'm not allergic like I was told and it was only a reaction. Thanks for the education. Nothing is impossible, but odds are you aren't allergic to epi. Glad you survived and I sincerely hope you don't need big dental work again. Now go brush your teeth!
|
|
Quoted:
Quoted:
Quoted:
Quoted:
Saying that you are allergic to epi is equivalent to saying that you are allergic to your own saliva, or your own sweat or urine. Epi is the same as adrenaline, which is made in your adrenal glands. It is theoretically possible to be allergic to a preservative in epi, although I have never actually seen or heard of a patient who really has this allergy. Epi causes flushing, elevated blood pressure, elevated heart rate, nausea, tremors, and a sense of doom (fight or flight response) when it is given IV. This is not an allergic reaction. This is what it is supposed to do, just like adrenaline does when someone is trying to kill you. So it caused my BP to spike, and then bottom out to the point where I collapsed? Guess that makes sense as it was not an immediate reaction and it happened in the waiting room as I was getting ready to leave after a root canal. There are several things that could have caused your "spell." You could have had a vagolytic vagal reaction to pain (very common, IMO it's more common among men). You may have had orthostatic hypotension. Either are more likely than a delayed reaction to epinephrine. I say delayed reaction because the injections of local with epi would typically occur before a root canal, and your reaction didn't occur until the point you were leaving the office. If you had a drug reaction that was severe enough to lower your blood pressure to a point that you were losing consciousness, that reaction would have been followed by a 911 call, and IV start, supplemental oxygen, and probably a trip to a hospital for some steroids, antihistamines, and epinephrine.
It did include a trip to the hospital in the back of a van with O2 and an IV. No idea about the others. I think they were being overly cautious, but that particular dentist said I should never have novacaine again. Imagine the fun of having a tooth subsequently quartered and extracted with only lidocaine to ease the pain. That was excruciating. Well, good to know I'm not allergic like I was told and it was only a reaction. Thanks for the education. FYI they don't even manufacture "novocaine" anymore. Lidocaine is the gold standard local anesthetic but there's four or five in the regular rotation - they're all good and safe. The fact that you never have trouble when they use epinephrine-free local anesthetic is a good hint that epi is best avoided. Epinephrine has an extremely short half life and every reaction I've seen has it's onset immediately after injections and tails off within ten minutes. It does sound to me like you went all vasovagal with a helping of orthostatic hypotension but a lot of dentists overreact. I just sit people up, hand them a magazine and tell them to relax for a while. Once they're able to stand and walk around without trouble they can go home. Oh, are you on blood pressure medicine? Beta blocker perhaps? |
|
Quoted:
So it caused my BP to spike, and then bottom out to the point where I collapsed? Guess that makes sense as it was not an immediate reaction and it happened in the waiting room as I was getting ready to leave after a root canal. It happened in a dental office. Odds are nonzero that what actually happened is that you got a big shot of local anesthetic that went intravascular and took you to the edge of LA toxicity. Most dentists inject based on landmarks with only cursory or non-existent aspiration prior to injection. The tissue itself in that region is highly vascularized, so even if they are diligent about aspiration prior to injection (which virtually none are) rapid absorption and vascular uptake is a risk. I wish I had a shiny nickel for every time a patient told me they were allergic to lidocaine or epinephrine based on an experience at a dental office. They're almost certainly not allergic to the lidocaine. They're definitely not allergic to the epinephrine. I would not hesitate to give epi to an "epi allergic" person who needed it. I'm not bashing dentists, but if one ever tells you you're "allergic" to the stuff he just injected in your mouth, take it with a grain of salt. Odds are you're not. Nobody is allergic to epinephrine. True allergies to local anesthetics are VANISHINGLY rare. Some of the preservatives in some formulation are a possible culprit. But most likely, you just got a bolus of epi and local anesthetic into a vessel. Even a small amount into an artery back there can take the short path to the brain and cause symptoms, including brief seizures. Quoted:
If I'm ever made Nurse General (as opposed to Surgeon General) I'd set up public health lever education on what is and what isn't an allergy Well, the current "surgeon general" of the Army is a nurse. Political correctness, equal opportunity, and the ongoing cultural and organizational decline of military medicine, all running amok. |
|
Quoted:
Quoted:
If I'm ever made Nurse General (as opposed to Surgeon General) I'd set up public health lever education on what is and what isn't an allergy
For what it's worth, I kind of see using local in SHTF as really only being useful for dental work. If it's a traumatic injury, or god forbid a surgery, yer in way over Local's head anyways. Wound closure / I&D (Irrigation and Debridement or Incision and Drainage) would be in pretty good pain anyways, what's a little more, and with the drainage types, the incision tends to help with pain and you wouldn't use local there anyways (not when there is infection present, wouldn't want errant bugs hijacking outside the wound via the injection tract to the body now, would we). Nitrous was used effectively as was Ether in the good old days, but they were both used by PROFESSIONALS and both have since been found to have their drawbacks / dangers. I work with Anesthesia providers every day and I have to say that they are crazy intelligent folks that have a massive grasp of their drugs and their effects. This topic of SHTF anesthesia has been around before, and I didn't chime in that time. I guess I feel compelled this time. We can arm chair all we want. We can cobble together Field medic kits. We can play warrior. One thing we shouldn't plan on doing is DIY healthcare. No Local anesthetic surgery, no fish antibiotic, and no IVs using turkey baster needles, surgical tubing, salt and bottled water (Shooter Movie referance for those not paying attention). (Rant Off) Sorry jim I hereby nominate you for nurse general.
Seriously there are a lot of "intolerances" that people list as allergies. Morphine makes me loopy, this antibiotic gives me diarrhea, etc, etc. When you claim something as an allergy then you NEVER receive that drug again. Don't completely write off a drug that you may need one day because it gave you diarrhea. My first patient the other day listed succinylcholine as a drug allergy. I thought to myself, "great, the first patient of the day probably has MH in his family history." He had never even heard of MH. When I questioned him about his reaction to succs was he said, "it makes me stop breathing." No shit. You should've seen the look on his face when I explained to him that was the therapeutic effect of the drug. The current Army "Surgeon" General is a nurse. I personally find that idiotic. I intend no offense to the quoted posters who IIRC are nurse practitioners themselves (but whom I imagine would never call themselves "surgeon") edit to add: DAMN! Beaten by one post! |
|
Quoted:
Quoted:
Quoted:
Quoted:
Quoted:
Saying that you are allergic to epi is equivalent to saying that you are allergic to your own saliva, or your own sweat or urine. Epi is the same as adrenaline, which is made in your adrenal glands. It is theoretically possible to be allergic to a preservative in epi, although I have never actually seen or heard of a patient who really has this allergy. Epi causes flushing, elevated blood pressure, elevated heart rate, nausea, tremors, and a sense of doom (fight or flight response) when it is given IV. This is not an allergic reaction. This is what it is supposed to do, just like adrenaline does when someone is trying to kill you. So it caused my BP to spike, and then bottom out to the point where I collapsed? Guess that makes sense as it was not an immediate reaction and it happened in the waiting room as I was getting ready to leave after a root canal. There are several things that could have caused your "spell." You could have had a vagolytic vagal reaction to pain (very common, IMO it's more common among men). You may have had orthostatic hypotension. Either are more likely than a delayed reaction to epinephrine. I say delayed reaction because the injections of local with epi would typically occur before a root canal, and your reaction didn't occur until the point you were leaving the office. If you had a drug reaction that was severe enough to lower your blood pressure to a point that you were losing consciousness, that reaction would have been followed by a 911 call, and IV start, supplemental oxygen, and probably a trip to a hospital for some steroids, antihistamines, and epinephrine.
It did include a trip to the hospital in the back of a van with O2 and an IV. No idea about the others. I think they were being overly cautious, but that particular dentist said I should never have novacaine again. Imagine the fun of having a tooth subsequently quartered and extracted with only lidocaine to ease the pain. That was excruciating. Well, good to know I'm not allergic like I was told and it was only a reaction. Thanks for the education. FYI they don't even manufacture "novocaine" anymore. Lidocaine is the gold standard local anesthetic but there's four or five in the regular rotation - they're all good and safe. The fact that you never have trouble when they use epinephrine-free local anesthetic is a good hint that epi is best avoided. Epinephrine has an extremely short half life and every reaction I've seen has it's onset immediately after injections and tails off within ten minutes. It does sound to me like you went all vasovagal with a helping of orthostatic hypotension but a lot of dentists overreact. I just sit people up, hand them a magazine and tell them to relax for a while. Once they're able to stand and walk around without trouble they can go home. Oh, are you on blood pressure medicine? Beta blocker perhaps? Nope, normal BP and on no medications |
|
Quoted:
Vodka! Doesn't deaden the pain as well, but the patient will have more fun!  We removed a couple large sebaceous cysts from my brother's scalp a month ago using 1% lido & epi. I had him premedicate and maintain with Stoli and we did it in his easy chair under sterile conditions. Procedure went well as planned. And he was drunk by the end of it. Closed with running subcuticular sutures. Healed up very nicely and saved on the doctor bill. Win-win.  Don't do this unless you know what you are doing!
EDIT: And have what you need to do it properly, safely and cleanly. |
|
Quoted:
If I'm ever made Nurse General (as opposed to Surgeon General) I'd set up public health lever education on what is and what isn't an allergy
For what it's worth, I kind of see using local in SHTF as really only being useful for dental work. If it's a traumatic injury, or god forbid a surgery, yer in way over Local's head anyways. Wound closure / I&D (Irrigation and Debridement or Incision and Drainage) would be in pretty good pain anyways, what's a little more, and with the drainage types, the incision tends to help with pain and you wouldn't use local there anyways (not when there is infection present, wouldn't want errant bugs hijacking outside the wound via the injection tract to the body now, would we). Nitrous was used effectively as was Ether in the good old days, but they were both used by PROFESSIONALS and both have since been found to have their drawbacks / dangers. I work with Anesthesia providers every day and I have to say that they are crazy intelligent folks that have a massive grasp of their drugs and their effects. This topic of SHTF anesthesia has been around before, and I didn't chime in that time. I guess I feel compelled this time. We can arm chair all we want. We can cobble together Field medic kits. We can play warrior. One thing we shouldn't plan on doing is DIY healthcare. No Local anesthetic surgery, no fish antibiotic, and no IVs using turkey baster needles, surgical tubing, salt and bottled water (Shooter Movie referance for those not paying attention). (Rant Off) Sorry jim "No Local anesthetic surgery, no fish antibiotic, and no IVs using turkey baster needles, surgical tubing, salt and bottled water..." Absolutely stay away from the fish antibiotics!!! 
|
|
Quoted:
Quoted:
Quoted:
If I'm ever made Nurse General (as opposed to Surgeon General) I'd set up public health lever education on what is and what isn't an allergy
For what it's worth, I kind of see using local in SHTF as really only being useful for dental work. If it's a traumatic injury, or god forbid a surgery, yer in way over Local's head anyways. Wound closure / I&D (Irrigation and Debridement or Incision and Drainage) would be in pretty good pain anyways, what's a little more, and with the drainage types, the incision tends to help with pain and you wouldn't use local there anyways (not when there is infection present, wouldn't want errant bugs hijacking outside the wound via the injection tract to the body now, would we). Nitrous was used effectively as was Ether in the good old days, but they were both used by PROFESSIONALS and both have since been found to have their drawbacks / dangers. I work with Anesthesia providers every day and I have to say that they are crazy intelligent folks that have a massive grasp of their drugs and their effects. This topic of SHTF anesthesia has been around before, and I didn't chime in that time. I guess I feel compelled this time. We can arm chair all we want. We can cobble together Field medic kits. We can play warrior. One thing we shouldn't plan on doing is DIY healthcare. No Local anesthetic surgery, no fish antibiotic, and no IVs using turkey baster needles, surgical tubing, salt and bottled water (Shooter Movie referance for those not paying attention). (Rant Off) Sorry jim I hereby nominate you for nurse general.
Seriously there are a lot of "intolerances" that people list as allergies. Morphine makes me loopy, this antibiotic gives me diarrhea, etc, etc. When you claim something as an allergy then you NEVER receive that drug again. Don't completely write off a drug that you may need one day because it gave you diarrhea. My first patient the other day listed succinylcholine as a drug allergy. I thought to myself, "great, the first patient of the day probably has MH in his family history." He had never even heard of MH. When I questioned him about his reaction to succs was he said, "it makes me stop breathing." No shit. You should've seen the look on his face when I explained to him that was the therapeutic effect of the drug. The current Army "Surgeon" General is a nurse. I personally find that idiotic. I intend no offense to the quoted posters who IIRC are nurse practitioners themselves (but whom I imagine would never call themselves "surgeon") edit to add: DAMN! Beaten by one post! The current "Surgeon" general is also a very nice lady. At least, in the 5 minutes I had to deal with her. But, don't get me started. Though, let's face it, the Navy should have a Surgeon Admiral, right?
|