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Chapter 58. Regional Anesthesia and Acute Pain Management in the Emergency Department

Which nerve needs to be blocked to produce an excellent anesthesia and analgesia to remove foreign bodies from the sole of the foot?

A. Tibial nerve

B. Superficial peroneal nerve

C. Deep peroneal nerve

D. Saphenous nerve

A is correct. Tibial nerve needs to be blocked to produce an excellent anesthesia and analgesia to remove foreign bodies from the sole of the foot.

B is incorrect. The dorsum of the foot is innervated by the superficial peroneal nerve.

C is incorrect. The webspace between first and second toes is innervated by the deep peroneal nerve.

D is incorrect. The saphenous nerve innervates the medial malleolus and a variable portion of the medial side of the leg below the knee.

Which of the following statements is true regarding ketamine?

A. Ketamine has a unique dissociative anesthetic effect at low doses (0.1–0.3 mg/kg IV).

B. Ketamine is an NMDA receptor agonist.

C. Ketamine is a potent analgesic at low doses (0.1–0.3 mg/kg IV).

D. S-ketamine is not suitable for use in the ED due to substantially increased risk of psychotropic side effects.

C is correct. Ketamine is a potent analgesic at low doses (0.1–0.3 mg/kg IV).

A is incorrect. Ketamine is an NMDA receptor antagonist with a unique dissociative anesthetic effect at higher doses (1–2 mg/kg IV).

B is incorrect. Ketamine is an NMDA receptor antagonist.

D is incorrect. While not available in the USA, S-ketamine is uniquely suitable for use in the ED due to substantially reduced psychotropic side effects.

Which of the following agents is suitable for emergency topical anesthesia in nonintact skin?

A. Eutectic 1:1 mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA)

B. 4% lidocaine cream in a liposomal matrix (LMX)

C. Vapocoolant spray

D. Lidocaine 4%, epinephrine 0.1%, and tetracaine 0.5% (LET)

D is correct. Lidocaine 4%, epinephrine 0.1%, and tetracaine 0.5% (LET), is suitable for emergency topical anesthesia in non-intact skin.

A, B, and C are incorrect. These agents are suitable for emergency topical anesthesia in the intact skin. See Table 58–1.

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