Author Archive for: robbryant13

Beyond ACLS: CPR, Defibrillation, and Epinephrine

23 Jul
July 23, 2015

Beyond ACLS - CPR, Defibrillation, & EpiAdvanced Cardiac Life Support (ACLS) provides a well structured framework for those who resuscitate infrequently. There is room to move beyond the algorithm to potentially provide better care for our patients for those who resuscitate frequently. I will describe some tweaks to the way CPR, defibrillation, and medications are delivered in the arrests I manage. Read more →

Skin Anesthesia: Lidocaine vs Bupivacaine +/- Epinephrine

23 Apr
April 23, 2015

 

Skin AnesthesiaWhen selecting a local anesthetic agent for skin wounds I have historically been taught to use lidocaine to provide a faster onset, and to use bupivacaine for a longer duration of action.

It can be time consuming to find 0.5% Bupivacaine with epinephrine and 2% Lidocaine with Epinephrine to produce a final mixture of 1% Lidocaine and 0.25% Bupivacaine with Epinephrine.

  • If there is no difference in effect between these agents time could be saved when drawing up local anesthetics.

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Lidocaine + Bupivacaine vs Bupivacaine Alone for Digital Nerve Blocks

09 Apr
April 9, 2015

Digital Nerve BlocksWhen I first learned digital nerve blocks in the late 1990’s I was taught to mix Lidocaine and Bupivacaine 50/50 to provide faster onset (Lidocaine) and a longer duration of action (Bupivacaine). My use of two agents for digital nerve blocks was recently questioned by one of my colleagues.

Any time additional medications are drawn up into a syringe there is opportunity for error, and there is additional time added to the procedure. A review of the (limited) literature will try to answer the following questions:

  1. Does the addition of Lidocaine to Bupivacaine decrease the time to onset of anesthesia?
  2. Does the addition of Lidocaine to Bupivacaine decrease the pain of injection?
  3. Does the use of Lidocaine with Epinephrine prolong the duration of digital block long enough to obviate the need for Bupivacaine?

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