تدبير الجروح anesthetize A

انتبه أيهما لا يستخدم بجروح النهايات (أصابع، صيوان الأذن، الأنف)؟

The use of epinephrine-containing auto-injectors as a prescription medication for treating routine to severe anaphylactic reactions is now widely accepted. Associated with this trend is an increasing number of accidental injections of epinephrine into digits, causing severe vasoconstriction and the risk of ischemic necrosis. When epinephrine is accidentally discharged into a digit, ischemic skin necrosis resulting from the alpha-adrenergic blocking effects of this agent can lead to the need for multiple operations, wound infection, and even loss of the digit. The alpha-adrenergic blocking characteristics of phentolamine administered by a variety of methods have proved effective in reversing the effects of epinephrine in these cases. The authors urge that the described treatment protocol become more widely disseminated among primary care and emergency physicians.

طيب سؤال، شو نوع الحقن وقت التخدير: تحت الجلد subcutaneous أم ضمن الأدمة intradermal؟
وبالتالي بتسحب المدحم قبل الحقن ولا مافي داعي؟

Pain from anesthetic infiltration is caused by distention of tissue from too-rapid injection with
too large a needle directly into the dermis. The acidity of the agent also contributes to the
pain. Pain from infiltration can be minimized by injecting slowly, subcutaneously, with a small,
25- or 27-gauge needle, directly through the wound margins. Buffering the anesthetic agent
with 1 mL of sodium bicarbonate for every 10 mL of lidocaine also can help to reduce pain.
However, bupivacaine does not lend itself to buffering because it precipitates as its pH rises.
Another efficacious and inexpensive method of decreasing the pain of infiltration is by
warming the anesthetic.

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Because of toxicity and allergic reactions, the ester agents have limited indications for local infiltration, except in patients with allergy to amide agents

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