Unintentional intra-arterial injection - Revision history

Mholtz: Text replacement - "->" to "→"

2017-02-09T03:38:50Z

Text replacement - "->" to "→"

← Older revision		Revision as of 03:38, 9 February 2017
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	#IA Papaverine 30MG followed by infusion of 180mg over 10 hours<ref>Arquilla, B, Gupta, R, Gernshiemer, J, and Fischer, M. Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department. J Emerg Med. 2000; 19: 139–143</ref>		#IA Papaverine 30MG followed by infusion of 180mg over 10 hours<ref>Arquilla, B, Gupta, R, Gernshiemer, J, and Fischer, M. Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department. J Emerg Med. 2000; 19: 139–143</ref>
	#Extremity sympatholysis with plexus or nerve block<ref>Berger, JL, Nimier, M, and Desmonts, JM. Continuous axillary plexus block in the treatment of accidental intraarterial injection of cocaine [letter]. N Engl J Med. 1988; 318: 930</ref>		#Extremity sympatholysis with plexus or nerve block<ref>Berger, JL, Nimier, M, and Desmonts, JM. Continuous axillary plexus block in the treatment of accidental intraarterial injection of cocaine [letter]. N Engl J Med. 1988; 318: 930</ref>
	#IA CCB -> Nicardipine IA infusion<ref>Boudaoud, S, Jacob, L, Lagneau, F, Payen, D, Servant, JM, and Eurin, B. Successful treatment of vasospastic acute ischaemia with intra-arterial nicardipine. Eur J Anaesthesiol. 1993; 10: 133–134</ref>		#IA CCB → Nicardipine IA infusion<ref>Boudaoud, S, Jacob, L, Lagneau, F, Payen, D, Servant, JM, and Eurin, B. Successful treatment of vasospastic acute ischaemia with intra-arterial nicardipine. Eur J Anaesthesiol. 1993; 10: 133–134</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: Text replacement - "Abx" to "antibiotic"

2016-07-31T10:07:40Z

Text replacement - "Abx" to "antibiotic"

← Older revision		Revision as of 10:07, 31 July 2016
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	===Antibiotics===		===Antibiotics===
	*Some clinicians advocate initiation of coverage for [[gram positive]] and [[anaerobic]] organisms if patient is IV drug abuser		*Some clinicians advocate initiation of coverage for [[gram positive]] and [[anaerobic]] organisms if patient is IV drug abuser
	*Troer et al. withheld Antibiotics in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with ~~Abx~~.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>		*Troer et al. withheld Antibiotics in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with antibiotic.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>

	===If Evidence of Vasospasm===		===If Evidence of Vasospasm===

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T11:52:03Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

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	*[[Allergic reaction]]		*[[Allergic reaction]]

	==~~Diagnosis~~==		==Evaluation==
	*Typically clinical		*Typically clinical

Rossdonaldson1: Text replacement - "Abx " to "Antibiotics "

2016-07-14T06:31:18Z

Text replacement - "Abx " to "Antibiotics "

← Older revision		Revision as of 06:31, 14 July 2016
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	===Antibiotics===		===Antibiotics===
	*Some clinicians advocate initiation of coverage for [[gram positive]] and [[anaerobic]] organisms if patient is IV drug abuser		*Some clinicians advocate initiation of coverage for [[gram positive]] and [[anaerobic]] organisms if patient is IV drug abuser
	*Troer et al. withheld ~~Abx~~ in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with Abx.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>		*Troer et al. withheld Antibiotics in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with Abx.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>

	===If Evidence of Vasospasm===		===If Evidence of Vasospasm===

Neil.m.young: Text replacement - "* " to "*"

2016-07-10T07:48:35Z

Text replacement - "* " to "*"

← Older revision		Revision as of 07:48, 10 July 2016
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	===Risk Factors<ref>Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===		===Risk Factors<ref>Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===
	* Obesity		*Obesity
	* Hypotension		*Hypotension
	* Procedurally difficult situations (ie. agitated patient, back of ambulance)		*Procedurally difficult situations (ie. agitated patient, back of ambulance)
	* Aberrant vascular anatomy		*Aberrant vascular anatomy

	===Pathophysiology===		===Pathophysiology===
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	===Medications known to cause severe injury if administered IA:===		===Medications known to cause severe injury if administered IA:===
	* Benzodiazepines		*Benzodiazepines
	* Barbiturates		*Barbiturates
	* Propofol		*Propofol
	* Penicillins		*Penicillins
	* Amphetamines		*Amphetamines
	* Phenothiazines		*Phenothiazines
	* Phenytoin		*Phenytoin
	* Heroin		*Heroin
	* Tubocurarine		*Tubocurarine
	* Atrcurium		*Atrcurium
	* TPN		*TPN
	* NaHCO3		*NaHCO3
	* Hypertonic Dextrose (D50)		*Hypertonic Dextrose (D50)

	==Clinical Features==		==Clinical Features==
	''Presentation is a spectrum of severity''		''Presentation is a spectrum of severity''
	===Symptoms===		===Symptoms===
	* Immediate: pain on injection, numbness, weakness		*Immediate: pain on injection, numbness, weakness
	* 30 min-24 hours: decreased cap refill, pallor, skin mottling, cramping, paresthesias motor deficit		*30 min-24 hours: decreased cap refill, pallor, skin mottling, cramping, paresthesias motor deficit
	* 24- 48 hours: swelling, edema, contractures, signs of compartment syndrome		*24- 48 hours: swelling, edema, contractures, signs of compartment syndrome
	* 1-2 weeks: clinical evidence of rhabdo, necrosis, gangrene, autoamputation<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>		*1-2 weeks: clinical evidence of rhabdo, necrosis, gangrene, autoamputation<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>

	===Tissue Severity Score===		===Tissue Severity Score===
	''Assesses severity of symptoms''		''Assesses severity of symptoms''
	* Skin color		*Skin color
	* Capillary refill		*Capillary refill
	* Distal sensation		*Distal sensation
	* Distal extremity temperature		*Distal extremity temperature

	:Receives 1 point for every finding that is abnormal		:Receives 1 point for every finding that is abnormal
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	===Goals of Management:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===		===Goals of Management:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===
	* Symptom relief		*Symptom relief
	* Evaluate and manage arterial spasm		*Evaluate and manage arterial spasm
	* Reestablish distal perfusion		*Reestablish distal perfusion
	* Manage clinical sequelae of tissue injury		*Manage clinical sequelae of tissue injury
	* Rehabilitation of limb		*Rehabilitation of limb

	===Initial steps:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===		===Initial steps:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===
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	===Antibiotics===		===Antibiotics===
	* Some clinicians advocate initiation of coverage for [[gram positive]] and [[anaerobic]] organisms if patient is IV drug abuser		*Some clinicians advocate initiation of coverage for [[gram positive]] and [[anaerobic]] organisms if patient is IV drug abuser
	* Troer et al. withheld Abx in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with Abx.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>		*Troer et al. withheld Abx in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with Abx.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>

	===If Evidence of Vasospasm===		===If Evidence of Vasospasm===

Neil.m.young: Text replacement - "# " to "#"

2016-07-09T20:43:52Z

Text replacement - "# " to "#"

Neil.m.young: Text replacement - " ==" to "=="

2016-07-07T05:26:20Z

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← Older revision		Revision as of 05:26, 7 July 2016
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	*Self-inflicted cases are also being described in patients with IVDA		*Self-inflicted cases are also being described in patients with IVDA

	===Risk Factors<ref>Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref> ===		===Risk Factors<ref>Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===
	* Obesity		* Obesity
	* Hypotension		* Hypotension
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	* Rehabilitation of limb		* Rehabilitation of limb

	===Initial steps:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref> ===		===Initial steps:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===
	# If iatrogenic, maintain catheter in place:		# If iatrogenic, maintain catheter in place:
	#*Start slow infusion of isotonic solution to keep patent		#*Start slow infusion of isotonic solution to keep patent

Neil.m.young: /* References */

2016-06-26T15:38:26Z

References

← Older revision		Revision as of 15:38, 26 June 2016
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	==References==		==References==
	<references/>		<references/>

			[[Category:Toxicology]][[Category:Critical Care]][[Category:Pharmacology]]

Rossdonaldson1: Rossdonaldson1 moved page Iatrogenic intra-arterial injection to Unintentional intra-arterial injection

2016-06-05T11:41:06Z

Rossdonaldson1 moved page Iatrogenic intra-arterial injection to Unintentional intra-arterial injection

← Older revision	Revision as of 11:41, 5 June 2016
(No difference)

Rossdonaldson1: /* Antibiotics */

2016-06-05T11:39:24Z

Antibiotics

← Older revision		Revision as of 11:39, 5 June 2016
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	===Antibiotics===		===Antibiotics===
	* Some clinicians advocate initiation of ~~Abx~~ coverage of gram positive and anaerobic organisms if patient is IV drug abuser		* Some clinicians advocate initiation of coverage for [[gram positive]] and [[anaerobic]] organisms if patient is IV drug abuser
	* Troer et al. withheld Abx in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with Abx.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>		* Troer et al. withheld Abx in this patient population if no sign of infection present. No cellulitic changes or spreading infection noted in those managed with Abx.<ref>Treiman, GS, Yellin, AE, Weaver, FA, Barlow, WE, Treiman, RL, and Gaspar, MR. An effective treatment protocol for intraarterial drug injection. J Vasc Surg. 1990; 12: 456–465</ref>

← Older revision		Revision as of 20:43, 9 July 2016
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	===Initial steps:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===		===Initial steps:<ref> Sen S, Chini E, Brown M. Complications After Unintentional Intra-arterial Injection of Drugs: Risks, Outcomes, and Management Strategies. Mayo Clinic Proceedings 2005. 80(6):783-795</ref>===
	# If iatrogenic, maintain catheter in place:		#If iatrogenic, maintain catheter in place:
	#*Start slow infusion of isotonic solution to keep patent		#*Start slow infusion of isotonic solution to keep patent
	#*to be used for arteriogram and administration of vasodilators		#*to be used for arteriogram and administration of vasodilators
	# Thoroughly evaluate medications administered through this catheter		#Thoroughly evaluate medications administered through this catheter
	# Evaluate severity of injury (soft compartments, neuro-vascular exam)		#Evaluate severity of injury (soft compartments, neuro-vascular exam)
	# Anticoagulation with IV [[heparin]] recommended		#Anticoagulation with IV [[heparin]] recommended
	# Treat pain and symptoms		#Treat pain and symptoms

	===Antibiotics===		===Antibiotics===
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	===If Evidence of Vasospasm===		===If Evidence of Vasospasm===
	Consider initiation of the following:		Consider initiation of the following:
	# IA Papaverine 30MG followed by infusion of 180mg over 10 hours<ref>Arquilla, B, Gupta, R, Gernshiemer, J, and Fischer, M. Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department. J Emerg Med. 2000; 19: 139–143</ref>		#IA Papaverine 30MG followed by infusion of 180mg over 10 hours<ref>Arquilla, B, Gupta, R, Gernshiemer, J, and Fischer, M. Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department. J Emerg Med. 2000; 19: 139–143</ref>
	# Extremity sympatholysis with plexus or nerve block<ref>Berger, JL, Nimier, M, and Desmonts, JM. Continuous axillary plexus block in the treatment of accidental intraarterial injection of cocaine [letter]. N Engl J Med. 1988; 318: 930</ref>		#Extremity sympatholysis with plexus or nerve block<ref>Berger, JL, Nimier, M, and Desmonts, JM. Continuous axillary plexus block in the treatment of accidental intraarterial injection of cocaine [letter]. N Engl J Med. 1988; 318: 930</ref>
	# IA CCB -> Nicardipine IA infusion<ref>Boudaoud, S, Jacob, L, Lagneau, F, Payen, D, Servant, JM, and Eurin, B. Successful treatment of vasospastic acute ischaemia with intra-arterial nicardipine. Eur J Anaesthesiol. 1993; 10: 133–134</ref>		#IA CCB -> Nicardipine IA infusion<ref>Boudaoud, S, Jacob, L, Lagneau, F, Payen, D, Servant, JM, and Eurin, B. Successful treatment of vasospastic acute ischaemia with intra-arterial nicardipine. Eur J Anaesthesiol. 1993; 10: 133–134</ref>

	==Disposition==		==Disposition==