共查询到17条相似文献,搜索用时 15 毫秒
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Salam GA 《American family physician》2004,69(3):585-590
Although local anesthesia usually is used in surgical procedures, field or nerve blocks can provide more effective anesthesia in some situations. In a field block, local anesthetic is infiltrated around the border of the surgical field, leaving the operative area undisturbed. In field blocks, epinephrine may be added to the anesthetic to enhance vasoconstriction and prolong the duration of anesthesia. In a nerve block, anesthetic is injected directly adjacent to the nerve supplying the surgical field. A review of regional anatomy and the location of nerves and other important structures is essential before administering the injection. Systemic toxicity is rare with regional anesthesia and can be prevented by using the smallest dose possible and aspirating before the injection. Supraorbital, supratrochlear, infraorbital, and mental nerve blocks can provide adequate anesthesia in procedures on parts of the face. Field block also may be considered when operating on the ear or lips. 相似文献
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Salam GA 《American family physician》2004,69(4):896-900
The hand can be anesthetized effectively with blocks of the median, ulnar, or radial nerve. Each digit is supplied by four digital nerves, which can be blocked with injections on each side of the digit. Anterior or posterior ankle blocks can be used for regional anesthesia for the foot. The anterior ankle block, which is used for procedures on the dorsum of the foot, involves blocking the saphenous nerve, and superficial and deep peroneal nerves. The posterior ankle block, which is used to anesthetize the sole of the foot, involves blocking the sural and posterior tibial nerves. Paracervical block is used for procedures on the cervix, such as loop electrocauterization or conization. Dorsal penile block has been the most commonly recommended anesthetic technique for neonatal circumcision. A safe and effective alternative is the application of anesthetic cream over the skin to be circumcised. 相似文献
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Morbid obesity is a serious and widespread disease that has considerable morbidity and mortality. Bariatric surgery has become widely available in both community and academic centers as a weight loss option for the morbidly obese. Although the procedure is offered to patients after a careful screening process, it is highly invasive and is performed in patients with significant pre-existing comorbidities from obesity. Knowledge of possible postoperative complications and their management is important as it will affect Emergency Departments nationwide. A basic understanding of the available procedures, the anatomical changes of each procedure, and the common complications for each is important to the emergency physician who will need to evaluate and manage the postbariatric surgery patient. 相似文献
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BackgroundAirway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described.ObjectivesOur aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children.MethodsA web-based survey of senior emergency physicians was distributed through the six research networks associated with Pediatric Emergency Research Network (PERN). Senior physician was defined as anyone working without direct supervision at any point in a 24-h cycle. Physicians were queried regarding their most recent clinical experience performing or supervising airway procedures, as well as with hands on practice time or procedural teaching. Reponses were dichotomized to within the last year, or ≥ 1 year. Confidence was assessed using a Likert scale for each procedure, with results for ETI and LMA stratified by age. Response levels were dichotomized to “not confident” or “confident.” Multivariate regression models were used to assess relevant associations.Results1602 of 2446 (65%) eligible clinicians at 96 PERN sites responded. In the previous year, 1297 (85%) physicians reported having performed bag-mask ventilation, 900 (59%) had performed intubation, 248 (17%) had placed a laryngeal mask airway, 348 (23%) had changed a tracheostomy tube, and 18 (1%) had performed a surgical airway. Of respondents, 13% of physicians reported the opportunity to supervise but not provide ETI, 5% for LMA and 5% for BMV. The percentage of physicians reporting “confidence” in performing each procedure was: BMV (95%) TTC (43%), and surgical airway (16%). Clinician confidence in ETT and LMA varied by patient age. Supervision of an airway procedure was the strongest predictor of procedural confidence across airway procedures.ConclusionBMV and ETI were the most commonly performed pediatric airway procedures by emergency medicine physicians, and surgical airways are very infrequent. Supervising airway procedures may serve to maintain procedural confidence for physicians despite infrequent opportunities as the primary proceduralist. 相似文献
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Ran D Goldman Sowmya Balasubramanian Paul Wales Sharon E Mace 《The journal of pain》2005,6(10):650-655
Inguinal hernias become incarcerated in 10% to -15% of children and reduction of the hernia is an urgent painful procedure. No recommendations exist for analgesia during this procedure. We surveyed pediatric emergency physicians (PEP) and pediatric surgeons (PS) for their analgesia and sedation use during the reduction. The survey was mailed to 19 centers in North America. A total of 56% (185/331) surveys were completed by PEP and 56% (68/122) from PS. A total of 96.7% (245/253) of responders reported giving analgesia or sedation during reduction. PS were more likely to use intravenous drugs, try for a longer time, wait longer between trials, and conduct more trials compared to the PEP. Clinically related variables were more important for PEPs than PS for analgesia and sedation. System-related variables were more important by PS for admission. PERSPECTIVE: This survey shows significant variability between specialties in the drugs, route, and number of attempts during reduction of a painful incarcerated hernia in children. Development of a sedation and analgesia protocol may be useful in order to unify management of pain and discomfort during hernia reduction. 相似文献
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The purpose of this study was to document analgesic use for limb and clavicle injuries in the pediatric emergency department (ED) and to determine whether a physician-oriented pain scale form on the patient's chart would enhance the administration of analgesia. Patients 3 to 18 years old were recruited prospectively in our tertiary pediatric ED in Toronto. The study included 4 crossover periods, 2 with the pain scale form on the patient's chart and 2 without. A total of 310 patients were recruited, mean age was 10 years, 64% were boys, and 62% had sustained fractures. The mean pain score was 4.4. Only 90 (29%) patients received an analgesic in the ED, and 65 (72%) of them were ordered by a physician. Only 24 (20%) in the study group and 22 (14%) in the control group received sufficient analgesia (P = .13). The median time to physician-initiated analgesia after arrival was 2.0 hours (1.0 to 3.3 hours), without a significant difference between groups. Pain control was 4-fold more appropriate in children receiving opioids versus nonopioids. Physician pain reminders did not enhance, and other measures should be taken to increase the dispensing of analgesia. PERSPECTIVE: This is the first study to evaluate whether the addition of a physician-oriented pain-scale form on the chart of patients with injuries improves administration of analgesia in the ED. We found that physicians do not give sufficient analgesia even with this reminder form. 相似文献
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Tamara L. Dorfman Elizabeth Sumamo Schellenberg Gwen R. Rempel Shannon D. Scott Lisa Hartling 《International journal of nursing studies》2014