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.

Read more →

April 2015 “Skeptical Edition” REBELCast

20 Apr
April 20, 2015

April 2015 "Skeptical Edition" REBELCastWelcome back to a special edition, or should I say “skeptical edition” of REBELCast. We have started to do something new by inviting guests onto the show to discuss papers in the literature they find interesting.  This month I had the pleasure of working with Ken Milne, an emergency room physician in Canada. Today, Ken and I are going to specifically discuss a new device that recently got FDA approval for CPR in Out of Hospital Cardiac Arrest (OHCA), and the question we are trying to answer is:

Is active Compression Decompression CPR with Augmentation of Negative Intrathoracic Pressure for Treatment of Out-of-Hospital Cardiac Arrest superior to standard CPR?

Read more →

Accelerated Diagnostic Protocol for Chest Pain Not Useful in a US Population?

16 Apr
April 16, 2015

Accelerated Diagnostic ProtocolThere are approximately 8 to 10 million patients coming to Emergency Departments (EDs) in the United States annually. In the US, we use a very liberal testing strategy in order to avoid acute coronary syndrome (ACS) in patients presenting with chest pain. This results in over 50% of ED patients with acute chest pain receiving serial cardiac biomarkers, stress testing, and cardiac angiography at an estimated cost of $10 to $13 billion annually and yet fewer than 10% of these patients are diagnosed with ACS.

The 2-hour accelerated diagnostic protocol (ADAPT) combines  0 and 2 hour cardiac troponin (cTn), electrocardiograms (ECGs), and an adapted Thrombolysis in Myocardial Infarction (TIMI) score to help identify ED patients safe for early discharge. Previous studies show that this strategy can identify as many as 20% of patients for early discharge with a high sensitivity of 97.9% to 99.7% for major adverse cardiac events (MACE) at 30 days. This ADP has yet to be tested in a US population until now.

Read more →

Do Patients with Posterior Epistaxis Managed by Posterior Packs Require ICU Admission?

13 Apr
April 13, 2015

Epistaxis MythsThis post is part 2 of epistaxis dogma. In the first post, we discussed the (dis)utility of prophylactic antibiotics in patients with epistaxis who require nasal packing. Here, we will take on dogma #2:

Dogma #2: Patients with posterior packs for epistaxis should be admitted to the ICU for continuous monitoring due to the risk of life-threatening bradydysrhythmias.

Unfortunately, the literature here is even sparser than with prophylactic antibiotics. An extensive literature search (paging research librarian) turned up two articles that were repeatedly cited. Read more →

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?

Read more →

Optimization WordPress Plugins & Solutions by W3 EDGE