USMLE Forum Archives - USMLE Step 2 CK - Surgery 6
Surgery 6
TheOne - 06-11-07 19:11
Paramedics bring a 26 years old man to the emergency department. The man suffered a motorcycle accident and has numerous abrasions and lacerations and a femoral fracture. After the patient is stabilized and his fracture is placed in traction, the rest of his body is examined for injuries. He has a laceration across his nose and nasolabial folds, a laceration on the lateral aspect of his penis, a large, oozing wound on his right hand, and an actively bleeding scalp laceration. Additionally, his left external auricle has a large laceration. While waiting for the attending orthopedic surgeon to arrive, a medical student on trauma service is encouraged to clean, anesthetize, and suture the man's numerous lacerations. The student plans to use a 2% lidocaine solution with epinephrine at a concentration of 1:100,000. For which of this patient's wounds is this method of local anesthesia and hemostasis most appropriate?
A. Ear
B. Hand
C. Nose
D. Penis
E. Scalp
TheOne - 06-11-07 19:11
Paramedics bring a 26 years old man to the emergency department. The man suffered a motorcycle accident and has numerous abrasions and lacerations and a femoral fracture. After the patient is stabilized and his fracture is placed in traction, the rest of his body is examined for injuries. He has a laceration across his nose and nasolabial folds, a laceration on the lateral aspect of his penis, a large, oozing wound on his right hand, and an actively bleeding scalp laceration. Additionally, his left external auricle has a large laceration. While waiting for the attending orthopedic surgeon to arrive, a medical student on trauma service is encouraged to clean, anesthetize, and suture the man's numerous lacerations. The student plans to use a 2% lidocaine solution with epinephrine at a concentration of 1:100,000. For which of this patient's wounds is this method of local anesthesia and hemostasis most appropriate?
A. Ear
B. Hand
C. Nose
D. Penis
E. Scalp
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#1
Re: Surgery 6 mosaabma - 06-11-07 19:32 E. Scalp..
Epinephrin is contraindicated in the other sites ( cause ishemia and gangrane in tissues with an end artery).....
#2
Re: Surgery 6 Sarahhh - 06-12-07 01:02 E.. scalp laceration.. its actively bleeding while all the other areas are oozing blood. which could mean that this is an some kinda artery involved... but yeah Mosaabma is right about the other effects of epinephrine..
#3
Re: Surgery 6 jwang - 06-13-07 11:51 Yeah I agree the answer is E because you should avoid epi on "fingers, toes, nose and hose" ;-)
#4
Re: Surgery 6
TheOne - 06-19-07 15:03 The correct answer is E. The injection of lidocaine with epinephrine is a convenient and commonly used technique to achieve both hemostasis and anesthesia. However, given the theoretical risk for ischemia from vasoconstriction, epinephrine should never be used in situations where there is no redundant blood flow. The scalp has an excellent vascular bed with redundant blood flow. Because scalp wounds can bleed profusely, the injection of a mixture of lidocaine with epinephrine is appropriate and safe.
Lidocaine without epinephrine should not be used at sites of end-organ perfusion, such as the ear (choice A), hand (choice B), nose (choice C), and penis (choice D).
#6
Re: Surgery 6 babbu5508 - 07-07-10 00:17 E. Scalp.... epinephrine would cause ischemia and sloughing if given to aprts like penis, ear, nos and fingers and toes...absolute contraindication
#7
Re: Surgery 6 bingousmle - 07-09-10 14:50 such high concentration of epinephrine is to be administered for scalp lacerations considering the rich vascular supply to the organ
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