injuries poisoning
How To Do Local Wound Infiltration
Equipment
Nonsterile gloves Barrier precautions as indicated (eg, face mask, safety glasses or face shield, cap and gown) Antiseptic solution (eg,chlorhexidine,povidone-iodine, alcohol) Syringe (eg, 1 to 10 mL) and needle (eg, 25 or 27 gauge) for anesthetic injection Injectable local anesthetic* (eg, 1%lidocaine† with or withoutepinephrine‡ 1:100,000, 25-gauge needle) Topical anesthetic§ (eg, LET solution: 4%lidocaine, 0.1%epinephrine, 0.5%tetracaine) plus cotton ball or dental pledget; optional and often used for children Tissue forceps (eg, Adson forceps), tissue hook as needed to expose the sides of the wound #11 scalpel blade for tissue undermining and debridement (if needed) * Local anesthetics are discussed in Lacerations . † Maximum dose of local anesthetics:Lidocainewithoutepinephrine, 5 mg/kg;lidocainewithepinephrine, 7 mg/kg;bupivacaine, 1.5 mg/kg. NOTE: A 1% solution (of any substance) represents 10 mg/mL (1 g/100 mL). ‡Epinephrinecauses vasoconstriction, which enhances hemostasis and prolongs the anesthetic effect. Patients with cardiac disease should receive only limited amounts ofepinephrine(maximum 3.5 mL of solution containing 1:100,000epinephrine); alternatively, use local anesthetic withoutepinephrine. Consider avoidingepinephrinein the distal extremities of patients with peripheral vascular disease. § The maximum dose of LET topical solution is 3 mL. When LET andlidocaineinfiltration are used together, the sum of thelidocainedoses must not exceed 5 mg/kg. 