emergency medications - for clinic

[TIVAndy]

does everyone have emergency airway/equipment/meds for in clinic procedure room?

i only do simple joint/nerve and some lumbar injections. rest goes to ASC. i did have one episode of contrast allergy last year which made me think i should at least have epi pen in clinic.. what are people doing and what kits/meds do you have?

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[Ferrismonk]

I do everything in office and have a full crash cart. Intubation supplies, suction, etc. Even have intralipid.

In your situation, at the absolute minimum I would have an AED, epi, steroids, benadryl, ambu-bag, oxygen.

 

[TIVAndy]

I do everything in office and have a full crash cart. Intubation supplies, suction, etc. Even have intralipid.

In your situation, at the absolute minimum I would have an AED, epi, steroids, benadryl, ambu-bag, oxygen.

thanks for the reply. this is helpful

 

[painfree23]

thanks for the reply. this is helpful

How often do u change out the intralipid? How expensive is it?

 

[soccrwz]

It is unlikely that you will ever use intralipid as you have to be giving a large volume/dose of local anesthetics usually bupivicaine, unless required there are other medications that are more likely to be used.

 

[Ferrismonk]

How often do u change out the intralipid? How expensive is it?

Change it out when it expires. Not sure how expensive it is honestly, company buys it.

It is unlikely that you will ever use intralipid as you have to be giving a large volume/dose of local anesthetics usually bupivicaine, unless required there are other medications that are more likely to be used.

Agreed. However better safe than sorry imo. I use a lot of local for the skin and when you're doing bilateral blocks on a small person, you can get somewhat close to the max dose. If a significant amount went intravascular, there could be issues (but probably not).

 

[lobelsteve]

Change it out when it expires. Not sure how expensive it is honestly, company buys it.


Agreed. However better safe than sorry imo. I use a lot of local for the skin and when you're doing bilateral blocks on a small person, youexpla can get somewhat close to the max dose. If a significant amount went intravascular, there could be issues (but probably not).

Please explain how you get close to toxicity using local anesthetic for blocks.

 

[soccrwz]

Maybe ICNB due to high vascular uptake, larger volume blocks like TAP, and Paravertebral; but its supposed to be given as an infusion after a bolus. Very few people are using 4% lidocaine, or have lidocaine bags that they use for cardiac. LAST for anesthesia blocks you need or IV lido infusions; we just aren't giving these doses or large volumes routinely or commonly.

 

[lobelsteve]

Never used more than 25cc 1% lido in any block, implant, etc.

Would not recommend having intralipid around in an outpatient setting.

 

[au bon pain]

Never used more than 25cc 1% lido in any block, implant, etc.

Current fellow here. Any tips on how to minimize local use for non-sedated BL Lumbar RFAs in the obese? The couple times I've been in the 25cc range have been with these players needing 150mm darts.

 

[TIVAndy]

Current fellow here. Any tips on how to minimize local use for non-sedated BL Lumbar RFAs in the obese? The couple times I've been in the 25cc range have been with these players needing 150mm darts.

sedate them.

 

[lobelsteve]

Numb skin. Advance until pressure. Numb fascia. Advance numb periosteum.
2cc per level max needed.

 

[SSdoc33]

Current fellow here. Any tips on how to minimize local use for non-sedated BL Lumbar RFAs in the obese? The couple times I've been in the 25cc range have been with these players needing 150mm darts.

i
Rarely use more than 15ml for a bilateral. Usually 10. Be more exact with needle placement. It comes with repetition

 

[Ferrismonk]

3-level bilateral RFA = 8 sites x 2mL 1% lido each site (16mL or 160mg Lido) plus 2mL 2% lido prior to burn each site (16mL or 320mg Lido) = 480mg Lidocaine. On a 100kg person, 100x5mg/kg = 500mg.

On a MBB I'm using the same lido for skin (160mg total), then using 0.25% bupivicaine for block (1-2mL-ish) (20-40mg).

Obviously I could use less local (or more sedation as TIVAndy suggests), but I'm a firm believer is using lots of local and waiting for it to work before moving forward. I think the patient experience is much better.

 

[SSdoc33]

3-level bilateral RFA = 8 sites x 2mL 1% lido each site (16mL or 160mg Lido) plus 2mL 2% lido prior to burn each site (16mL or 320mg Lido) = 480mg Lidocaine. On a 100kg person, 100x5mg/kg = 500mg.

On a MBB I'm using the same lido for skin (160mg total), then using 0.25% bupivicaine for block (1-2mL-ish) (20-40mg).

Obviously I could use less local (or more sedation as TIVAndy suggests), but I'm a firm believer is using lots of local and waiting for it to work before moving forward. I think the patient experience is much better.

patient experience is better when they can actually walk out of the procedure suite.

2mL 2% lido prior to burn is a ton -- especially if you are burning 8 sites at a time.

 

[lonelobo]

3-level bilateral RFA = 8 sites x 2mL 1% lido each site (16mL or 160mg Lido) plus 2mL 2% lido prior to burn each site (16mL or 320mg Lido) = 480mg Lidocaine. On a 100kg person, 100x5mg/kg = 500mg.

On a MBB I'm using the same lido for skin (160mg total), then using 0.25% bupivicaine for block (1-2mL-ish) (20-40mg).

Obviously I could use less local (or more sedation as TIVAndy suggests), but I'm a firm believer is using lots of local and waiting for it to work before moving forward. I think the patient experience is much better.

Wow

I don't use any anesthetic for skin with MBB

use a about a CC of 1% Lido for RF in Back, 1/2 cc in neck with no sedation....patients tolerate fine

 

[SSdoc33]

Wow

I don't use any anesthetic for skin with MBB

use a about a CC of 1% Lido for RF in Back, 1/2 cc in neck with no sedation....patients tolerate fine

same

 

[Ducttape]

I never do 3 level RFA.

oddly enough, and maybe its because I hate documenting, but everyone getting lumbar RFA ends up getting 5 ml 1%, 5ml 0.25%, and 4 ml 2%. and half that for cervicals.

 

[strike5858]

A few weeks back someone had posted a link to a company that sells a crash cart type bag that they refill for free when meds expire. Can’t seem to find that link. Can anyone share it if they know what I am referring to.