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This document defines key terms related to local anesthesia and describes the ideal properties, constituents, and administration methods of local anesthetic agents. It discusses that local anesthetics work by reversibly blocking nerve impulses, lists important properties like potency, safety, and rapid onset, and describes common agents like lidocaine and bupivacaine. It also outlines techniques for maxillary and mandibular anesthesia, including inferior alveolar nerve blocks and other regional methods.
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![Tips for painless injection
Control
Communication
Confidence
slow injection[slower still in tense tissue]
Pre-anesthesia
Needle insertion[sharp &slow]
Distraction
Small guage needles
Solution warming](https://image.slidesharecdn.com/la-141021100531-conversion-gate02/85/La-18-320.jpg)
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Gait , ab normal gait,normal biomechanics,pathomechanics of gait,unilateral stance,factors affectoing gait When is the Right Time to Refer to (Advanced) Heart Failure?
When is the Right Time to Refer to (Advanced) Heart Failure?Duke Heart
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Adam DeVore, MD, MHS
Duke University THE EYELID PPT FOR 1ST YEAR BSC OPTOMETRY
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THIS IS THE NOTES FOR EYELID ANATOMY AND SOME PHYSIOLOGY WHICH WILL HELP FOR 1ST YEAR OF BSC OPTOMETRY Ophthalmic Techniques HSSC-1 | Federal Board Past Paper | 2025 Preparation.pdf
Ophthalmic Techniques HSSC-1 | Federal Board Past Paper | 2025 Preparation.pdfazkaimran130
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HSSC-1 Ophthalmic Technology | Federal Board Past Paper Solved 鏝
Welcome to our channel! In this video, we cover the Federal Board Ophthalmic Techniques Past Paper for HSSC-1, including:
Multiple Choice Questions (MCQs) Section A (20 Marks)
Short Questions Section B (50 Marks)
Long Questions Section C (30 Marks)
Latest Exam Pattern | 2025 Preparation Guide
Time Management Tips Included!
This video is perfect for students preparing for HSSC-1 Ophthalmic Technology exams under the Federal Board of Intermediate and Secondary Education (FBISE).
Dont forget to like, share, and subscribe for more solved papers and exam tips!
#OphthalmicTechnology #FBISE #HSSC1 #PastPaper #MedicalTechnology #OphthalmicTechniques #FederalBoard #MCQs #ShortQuestions #LongQuestions #BoardExam2025whooping cough community health nursing.
whooping cough community health nursing.ASWIN S
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Whooping cough for BSC 5th sem community health nursing..
This includes
Introduction
Definition
Incidence
Incubation period
Causes
Clinical manifestations
Diagnostic evaluation
Treatment
Prevention
Complications
Of whooping cough....Devices in the Management of Acute Heart Failure (or) Cardiogenic Shock
Devices in the Management of Acute Heart Failure (or) Cardiogenic ShockDuke Heart
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M. Imran Aslam, MD
Duke University Exomind in General Aesthetics - with June 10, 2025 updates
Exomind in General Aesthetics - with June 10, 2025 updateslcadymd1
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Hi. This is Dr. Cady writing. This is the updated presentation compared to the original one given in Hong Kong on June 3rd. The rationale behind the update is my further reflection on the interesting concept of "mental wellness" which has been identified as a treatment target with a modified TMS protocol developed by BTL. It should be clearly noted that this device is definitely approved in the USA for the treatment of depression according to old TMS protocols. The "depression protocol" involves a minimum of 30 treatments, administered over 5 - 6 weeks, with one treatment typically on every weekday (M-F).
In contrast, the "wellness protocol" developed by BTL for this device has been successfully used in a study on "mental wellness" with just FOUR treatments administered, and in the study for food cravings and self control with just SIX treatments administered. Additionally, I demonstrate in this presentation the remarkable power of this TMS device to eliminate depression and anxiety in two patients presented after just two back to back treatments.
It should be clearly noted that this is not an official BTL protocol, nor the position of the company, and the use of this device for mental wellness is not "FDA approved." It is also not FDA approved for the aggressive treatment protocol I share in this presentation. Given that this device is used per physician discretion, and given that the scientific literature supports the idea that the more pulses or treatments delivered in a day increase the effectiveness of the treatment and the rapidity of onset, this aggressive treatment seemed to me to be scientifically valid, and safe. Scrupulous informed consent was obtained from the patients prior to administering the treatments in the manner I have illustrated herein. I am not necessasrily recommending tretments in this manner. But I include them and note them because they reveal, dramatically, the capability of this device to change people's lives with the most serious cases. The impact, therefore, on just "lack of mental wellness" or "food cravings and impulse control is very reasonable.
It is my belief that 4 - 6 treatments in a general aesthetic or "wellness" practice should be sufficient. For the harder cases that a psychiatrist would see, there is some argument that even six treatments, administered with three "couplet" or "paired" treatments, could be remarkably beneficial.
In this presentation, I review the epidemiology of depression, anxiety and the topic of simply being "mentally unwell" while not being necessarily diagnosed with depression or anxiety. It is the lack of mental wellness and addressing it with this helpful modality that is so tremendously exciting.
A rough comparison of the relative treatment potency and effects of the Exomind versus older technology is included, pointing the way toward the logical assumption that, indeed, merely a few treatments (4 - 6) could have significant benefits in our patients.Multidisciplinary Strategies in GDMT Implementation
Multidisciplinary Strategies in GDMT ImplementationDuke Heart
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Aferdita Spahillari, MD
Duke University Guideline Directed Medical Therapy: What is the Best Approach?
Guideline Directed Medical Therapy: What is the Best Approach?Duke Heart
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Benjamin Trichon, MD
Duke University5-Lift Analysis in ergonomics focuses on evaluating the safety and efficienc...
5-Lift Analysis in ergonomics focuses on evaluating the safety and efficienc...Bolan University of Medical and Health Sciences ,Quetta
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Lift Analysis in ergonomics focuses on evaluating the safety and efficiency of manual lifting tasks in the workplace. It involves assessing the physical demands placed on the human body during lifting activities to prevent musculoskeletal disorders (MSDs), particularly lower back injuries5-Lift Analysis in ergonomics focuses on evaluating the safety and efficienc...
5-Lift Analysis in ergonomics focuses on evaluating the safety and efficienc...Bolan University of Medical and Health Sciences ,Quetta
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Ad
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- 1. DEFINITIONS ANAESTHESIA This is loss of all forms of sensation including pain, touch, temperature and pressure sensation which may be accompanied by impairment of motor function. ANALGESIA Loss of pain sensation unaccompanied by loss of other forms of sensibility.
- 2. IDEAL PROPERTIES OF LA AGENT POTENCY AND RELIABILITY- Should effectively produce analgesia when administered in adequate dosage. REVERSIBILITY OF ACTION- Must be completely reversible within predictable time. SAFETY- Should not be toxic. Therapeutic Lethal dose(LD50) ratio = Effective dose(ED50) The higher the ratio the greater the safety margin. LACK OF IRRITATION- It should be isotonic with a pH compatible to that of the tissues.
- 3. IDEAL PROPERTIES- Contd RAPIDITY OF ONSET- Ideally, injection should be followed by immediate onset of LA. DURATION OF EFFECT The effect last till the completion of treatment. STERILITY ADEQUATE SHELF LIFE- Average is 2-2.5 years. PENETRATION OF MUCOUS MEMBRANE- It should have penetrating ability.
- 4. CONSTITUENTS OF LOCAL ANAESTHETIC SOLUTIONS Local anaesthetic agent Vasoconstrictor Reducing agent Preservative Fungicide vehicle
- 5. LA AGENT ESTER LINKAGE- e.g. Procaine, Cocaine, Tetracaine. AMIDE LINKAGE e.g. Lignocaine, Prilocaine, Mepivacaine, Articaine, Etidocaine, Bupivacaine. Short acting 3% Mepivacaine (20-40mins) 4% Prilocaine (5-10mins)
- 6. Long acting a) 2% Lidocaine with VC (60mins) b) 0.5% Bupivacaine with VC (>90mins) c) 1.5% Ethidocaine with VC (>90mins) d) 4% Articaine (60mins) e) 4% Prilocaine with VC (60-90mins)
- 7. CONSTITUENTS OF LA AGENT Contd. VASOCONSTRICTORS a. Adrenaline-A synthetic substance similar to that secreted in human body b. Felypressin- A synthetically produced polypeptide similar to that secreted from human posterior pituitary gland. It is contraindicated in pregnant women because it is believed to have an oxytocin-like effect. c. Noradrenaline- The common concentrations of adrenaline or noradrenaline are;1:50,000 1:80,000 1:100,000. Felypressin is only available in citanest in a concentration of 0.031U/ml.
- 8. Advantages; Reduces toxic effect by retarding the absorption of the constituents. By confining the local anaesthetic agent to a localised area, it increases the depth and duration of anaesthesia. Produces a bloodless field of operation for surgical procedures.
- 9. DILUTION OF VASOCONSTRICTOR Dilution of vasoconstrictor is commonly referred to as a ratio of 1:1000. A conc. Of 1:1000 means that 1gram (1000mg) of solute (drug) contained in 1000ml of solution. ie 1:1000 dilution contains 1000mg in 1000ml or 1.0mg/ml of solution.
- 10. Maximum safest dose of lidocaine adult dose Lidocaine without vasoconstrictor is 300mg Lidocaine with vasoconstrictor is 500mg. 2% of lidocaine=20mg/ml ie 20mg=1ml X=1.8ml X=1.8x20 X=36mg of lidocaine in one ampule. Number of ampules that can be safely used for the pt in one visit=500mg/36, 14mg/ml.
- 11. Weight (more accurate) Lidocaine without vasoconstrictor =4.4mg/kg Lidocaine with vasoconstrictor= 7mg/kg
- 12. Children dose(clarks rule) Always deals with weight of pt. Dose of child=weight of child in pounds/150adult dose. Youngs rule Always deals with age of pt. Age of pt adult dose/age of pt12
- 13. Healthy patient 0.2mg of epinephrine In pt with cardiac problem=0.04mg
- 14. REDUCING AGENT Sodium bimetasulphite in small quantity is included in the solution to prevents oxidation of the vasoconstrictors as they are unstable in solution, especialy on exposure to sunlight.
- 15. CONSTITUENTS Contd. PRESERVATIVE Caprylhydrocupreinotoxin in xylotox helps to maintain sterility of the solution and also increases its shelf life. FUNGICIDE Thymol prevents proliferation of minute fungae which cause cloudiness of the solution.
- 16. VEHICLE Ringers solution(modified) is an isotonic solution in which all the other constituents are dissolved to minimize discomfort during injection of the LA.
- 17. MODE OF ACTION LA agent is made up of a weak base and strong acid which is hydrolyzed in the alkaline medium of human tissues to liberate the alkaloid base. This stabilizes the axonal limiting membrane of the nerve fibres thereby preventing the inflow of sodium ions into the cell and the resultant depolarization of the cell membrane. Impulse conduction is thus prevented so that pain stimulus is not transmitted.
- 18. Tips for painless injection Control Communication Confidence slow injection[slower still in tense tissue] Pre-anesthesia Needle insertion[sharp &slow] Distraction Small guage needles Solution warming
- 19. METHOD OF LA ADMIN TOPICAL Suitable LA is applied either to an area of skin or mucous membrane which it penetrates to act at the superficial nerve endings. Sprays : 10% Lignocaine HCl Ointment : 5% Lignocaine HCl Emulsion : 2% Lignocaine HCl
- 20. INFILTRATION Submucous injection : the solution is deposited just beneath the mucous membrane. This method is used for anaesthetizing the long buccal nerve. Sub-periosteal injection: The solution is deposited between periosteum and cortical plate of bone. E.g in palate.
- 21. Supra-periosteal injection: The solution is deposited outside the periosteum. Most frequently used in the maxilla where the cortical plate of the alveolar bone is thin and perforated by tiny vascular canals.
- 22. METHOD CONTD Intraosseous-The solution is deposited within the medullary bone. Intraseptal- The solution is deposited into the soft bone of the alveolar crest.
- 23. REGIONAL BLOCK This is deposited near the nerve trunk and blocks the areas supplied by the nerve trunk. It is reliable in the mandible due to the thickness of the bone.
- 24. LA IN MAXILLA MAXILLARY Posterior superior alveolar nerve block: The upper 3rd,2nd and the distobuccal and palatal roots of the 1st molar are innervated by posterior superior alveolar nerve. LA is deposited between the 2nd and 3rd molars. Serves the three maxillary molars and related buccal soft tissue (except the MB root of 1st molar).
- 25. METHODS Contd. Anterior and middle superior alveolar nerve The mesiobuccal root of the 1st molar, both pre molars are supplied by this nerve. LA is deposited just above the upper limit of the attached gingivae with the needle in-line with the long axis of the tooth. Serves premolars, all anterior teeth and overlying buccal mucosa and bone.
- 26. LA IN MAX CONTD GREATER PALATINE NERVE This is given over the estimated area of the apex of the root and should never be deposited distal to the 2nd molar because it will produce anaesthesia of the soft palate and uvular area making swallowing difficult for the patient. NASOPALATINE NERVE This is deposited beneath the incisive papilla at a site lateral to central rugae and deposited slowly to reduce discomfort. Provides anaesthesia of hard and soft tissue of the pre maxilla as far as the distal aspect of the 1st premolar.
- 27. LA IN MANDIBLE Due to the density of the buccal plate of bone infilteration technics are of limited value in the mandible and regional or block anaesthesia is most frequently used. E g inferior alveolar nerve block is done in the pterygomandibular space. PTERYGOMANDIBULAR SPACE Anaesthesia in the mandible is achieved by deposition of the solution around the inferior alveolar and lingual nerve in the pterygo-mandibular space.