CMAC221 WK01 Lecture EmergencyAcupuncture · acupuncture will be introduced along with an Introduction to microsystems (ear, hand, face and scalp). Balance (I-Ching) acupuncture will

© Endeavour College of Natural Health endeavour.edu.au 1

CMAC221

Session 1

Emergency Acupuncture

Chinese Medicine

Department


Pre Readings

o Cohen, M., Parker, S., Taylor, D., Smit, D. V.,

Ben-Meir, M., Cameron, P., & Xue, C. (2011).

Acupuncture as analgesia for low back pain,

ankle sprain and migraine in emergency

departments: Study protocol for a randomized

controlled trial. Trials, 12(1), 241.

http://doi.org/10.1186/1745-6215-12-241

o Cohen, M. M., Smit, D. V., Andrianopoulos,

N., Ben-Meir, M., Taylor, D. M., Parker, S. J.,

… Cameron, P. A. (2017). Acupuncture for

analgesia in the emergency department: a

multicentre, randomised, equivalence and

non-inferiority trial. The Medical Journal of

Australia, 206(11), 494–499.

http://doi.org/10.5694/mja16.00771


Pre Readings

o Grissa, M. H., Baccouche, H., Boubaker, H.,

Beltaief, K., Bzeouich, N., Fredj, N., …

Nouira, S. (2016). Acupuncture vs

intravenous morphine in the management of

acute pain in the ED. American Journal of

Emergency Medicine, 34(11), 2112–2116.

http://doi.org/10.1016/j.ajem.2016.07.028

o Zhang, A. L., Parker, S. J., Smit, D. V., Taylor,

D. M., & Xue, C. C. L. (2014). Acupuncture

and standard emergency department care for

pain and/or nausea and its impact on

emergency care delivery: a feasibility study.

Acupuncture in Medicine : Journal of the

British Medical Acupuncture Society, 32(3),

250–256. http://doi.org/10.1136/acupmed-

2013-010501


Christopher Marks, 2010


The Skill of Self Confidence

o See Dr. Ivan Joseph TEDx

Talk here

o The 10,000 hour rule –

Malcolm Gladwell

o Key message keep

Practicing and back your

self

Walter Lim, 2014

Videos: Tedx, 2012

SusanLuciaAnnunzio, 2011

https://www.youtube.com/watch?v=w-HYZv6HzAs

https://www.youtube.com/watch?v=XS5EsTc_-2Q


What's the Subject About?

o CMAC221 is all about exposing you to

as many different ways of treating

included under the Chinese Medicine

umbrella

o While points are important

o Understanding the theory of why you

would or would not use an individual

technique is more important

o This gives you several levels of

redundancy in treating – what else can

you do when one approach does not

work Image: Ron Mader, 2013


Chef Vs Cook

o A cook follows the recipe step by

step and does not develop or

create on their own

o A chef can create a great meal by

knowing and understanding what

flavours go together

o Only remembering points will trap

you at the level of a cook

o Understanding the theory will give

you the freedom to become a chef

o Aspire to be the ChefImage: Jedi94, 2013


CMAC222 – Subject Rationale

“Acupuncture Therapeutics 2 expands on the content

developed in Acupuncture Therapeutics 1 (CMAC211).

Acupuncture needling, is expanded upon and applied in

conjunction with a range of allied Traditional Chinese

medicine interventions. Techniques such as guasha

(scraping), bleeding, dermal hammer, laser and electro-

acupuncture will be introduced along with an Introduction to

microsystems (ear, hand, face and scalp). Balance (I-

Ching) acupuncture will also be included in this subject.

Students will differentiate between Chinese medicine

therapeutics to determine appropriate treatment and

discover known and possible mechanism of action.”


Learning Outcomeso Describe and apply hygiene, asepsis practices, infection

control and management of sharps and biohazards in line with

the CMBA guidelines as they relate to each Chinese medicine

therapeutic technique.

o Compare and contrast Chinese medicine therapeutic

techniques to achieve appropriate clinical outcomes for

presenting conditions.

o Demonstrate knowledge and skill when using each Chinese

medicine therapeutic technique on fellow students.


Learning Outcomes

o Develop and describe effective treatments using

Chinese medicine therapeutic techniques

o Identify and apply emergency acupuncture and first aid

practices as required.

o Evaluate individual patient needs and modify practices

showing due respect for privacy, cultural and other

differences in line with CMBA Code of Conduct.

http://www.chinesemedicineboard.gov.au/Codes-Guidelines.aspx


Don’t Forget ThisEssential tools this

semester are:

Lancets – get the

diabetic lancets

Gua sha tool

(ceramic spoon)

Dermal Hammers

Cupping and Moxa

will only be covered

if there is time

Get the Kit Now

Mannix, 2014

https://www.endeavourbookstore.com.au/product/acupuncture-kit/




Including the electro

o The subject will have three weeks allocated to this, and a

unit is required for the practical exams

Helio Medical supplies 2016

It is important that

you purchase an

electro machine

that you can have

complete control

over the frequency.

Contact the

Brisbane Bookstore

on 07 3253 9525


Assessments – Yes it can be this

obvious

Mr Hannon, 2011


Continuous Skill Development


Assessment Items

Type Learning

Outcome

Session

Content

Due Weighting

Continuous

Skill

Development

1-6 1-13 Sessions1-13 Pass/Fail

Practical Exm 2,4 1-7 Session 8 40%

Written

Assignment

1,3,6 1-12 Week 12 20%

Final Theory

Exam

1,2,4,5,6 1-13 Final Exam

Period

40%

The overall pass rate for this subject is 50%.

Additionally, students must pass the final theory assessment with a mark not

less than 50%.


Written Assignment



o Thousands of years ago the Chinese

Doctor would have seen emergencies

o Many classical texts cite such conditions

o These may have ranged from myocardial

infarctions to acute fevers to labours

needing further interventions

o Do you think that acupuncture and

Chinese medicine are the best form of

medical care to recommend for such

emergencies?

o This does depend on the emergency

Emergency Medicaid, 2015



o Acupuncture can be an adjunct therapy for some

emergencies

o Zhang et al. 2014, showed that acupuncture in the ED

appears safe and acceptable for patients with pain and

or nausea

o Cohen et al. 2017, concluded “The effectiveness of

acupuncture in providing acute analgesia for patients

with back pain and ankle sprain was comparable with

that of pharmacotherapy. Acupuncture is a safe and

acceptable form of analgesia.”

o However, acute conditions such as pain, fever, asthma,

severe diarrhoea, have all been identified by the WHOZhang et al, 2014, p25-6, Cohen et al. 2017, p494, WHO 2002

http://apps.who.int/iris/bitstream/10665/42414/1/9241545437.pdf?ua=1


Acupuncture Vs Morphine in ED

Primary outcome was 50% pain reduction of initial value in pain score

Acupuncture Group (150) Morphine Group (150)

Significant Pain

Reduction

92% 78%

Resolution time for

pain relief

16 minutes 28 minutes

Minor adverse

events

2.6% 56.6%

Conclusion:

This article provides an update on one of the oldest pain relief techniques

(acupuncture) that could find a central place in the management of acute care

settings. This should be considered especially in today's increasingly complicated

and poly medicated patients to avoid adverse drug reactions.Grissa et al. 2016 p2112


Principles of Treatment

o The use of the Jing well points

and GV26 for all acute

emergencies.

o The use of points like LI 4, PC4

and Yaotongxue (back of the

hand) for rapid relief of pain and

spasm.

o The use of ahshi points to relieve

local pain.

o The use of xi cleft points for

acute conditions involving the

Zang Fu or channel.Deadman, 2007, Bensky & O’Connor, 1981

Image:Back Pain, 2014


Principles of Treatment

o The use of specific points for

symptoms, e.g. PC6 for

palpitations or vomiting.

o The use of points like GV20 for a

controlling effect on all the

channels plus a sedative and

calming effect.

o Use of ear points to relieve pain,

fainting and insomnia.

o Common sense first aid

measures.Deadman, 2007, Bensky & O’Connor, 1981

Image: MaxxxL, 2015


Epileptic Attack, Hysterical Attack,

Febrile Fit

o These conditions may be from

various underlying aetiologies, in all

cases GV26 – with needle or firm

acupressure. If the attack is

severe, GV26 and KI1 - active

needle manipulation.

o LU11 and Shixuan (tips of fingers)

Prick to cause bleeding.

o HE6 (Xi cleft) with high stimulation.

o A threading method can also be

used. Needle HE5 through to HE7

bilaterally. Deadman, 2007, Bensky & O’Connor, 1981

Image: Jon-e, 2007


Severe Headache

o With any severe headache,

differentiation needs to be made by

which channel is effected, then

treat accordingly.

o LI4 can be used in many cases.

o GV20 can be used to sedate the

patient.

o Three Yin or 3 Yang Jing Wells on

either hand of foot

o Ear points brain, occiput and brain

stem may be utilised either pressed

with a thin object or needled.Deadman, 2007, Bensky & O’Connor, 1981

Image: 1970 BC, 2008


Heat Stroke/ High Fever

o Mild – dizziness,

tightness of chest,

high fever, lack of

perspiration, pain and

soreness of the whole

body

o GV14, LI11, LI4,

ST44, PC6

o GV14 1st then others

o Severe – coldness of

extremities with

perspiration, pallor,

palpitations, possible

unconscious or coma

o GV26 & Shixuan

Points

o PC3 & BL40 - Bleed

Deadman, 2007, Bensky & O’Connor, 1981


Bronchial Asthma

o Most effective and easy to

get to is CV22, finger

pressure is effective to

relieve spasm

o LU6 (Xi Cleft)

o Dingchuan (Stop wheezing)

o CV17 also useful

Deadman, 2007, Bensky & O’Connor, 1981

Image: KristyFaith, 2009


Cautions and Contraindications

o Top of skull infants – fontanels

o Pregnant women – forbidden points

o Hemophilia & other clotting disorders

o Intoxicated – All forms

o Organs – inc. sense and sex

o Pacemakers – no electro

o Patients with artificial or valve replacements – intradermal

needling

o Epileptic patients with a recent history of seizure

o Diabetic patients

o Red Flag symptomsChang, 2011, p79-80, Norris, 2001, p133

Image: Eugene Zemlyanskiy, 2005


Management of accidents

Faintingo Prodromal: dizziness, fidgets,

nausea, pale face, excessive

sweating

o Remove needles, lie client down,

offer warm water to sip.

o If more severe; use a fingernail or

needle arm GV26, PC9, KI1,

ST36 or moxa GV20, CV6, CV4.

o No further treatment that day.

Deadman, 2007, p654

Image: WikiMedia Commons


If they don’t recover quickly

o First Aid Principles

o Conditions worsen or

patient is unresponsive

emergency procedures

should be taken

Images: Is0b3lpalm3rs0n, 2008, Paul Long, 2008


Prevention

o Much easier to focus on prevention

o Informed consent

o Choose a comfortable position

o Start gentle and become more vigorous if needed

o Ask the patient when they last ate

o Does the patient have a history of fainting

o Take cues for the patient while they are getting the

needles

o Act quickly if you suspect it to minimise other harm

Chang, 2011, p70

Image:DidE



Stuck needle

o Check for excessive rotation in

one direction and rotate opposite

o Leave needle, massage locally

and then withdraw with gentle

rotation

o Moxa locally

o Insert needle nearby

o See the companion DVD for a demonstration for all of these

conditions Chang, 2011, Needling techniques for acupuncturists

basic principles and techniques, Singing Dragon, London

Chang, 2011, p71 and front cover


Stuck or bent needleo Often loosens if left alone for a few

minutes

o Lightly stroking or massaging the skin

near the point

o Apply warmth

o If fails, insert another needle an inch or

so from first. (This scatters the

concentration of Qi blood)

o If due to excess twirling – twirl in the

opposite direction

o Never try to force a stubborn needle

Chang, 2011, p71-2, Norris, 2001, p131-2


Bent needle

oAvoid excessive client movements

o If the client has moved, have them

return to the original position

oWithdraw needle slowly following the

course of the bend

Chang, 2011, p72


Broken needle

o Imperfections in the body of the

needle

o The sudden movement of the

patient

o Strong muscle contractions

o Excess force during needle

manipulation

o Unlikely to happen with modern

needle making technology –

more from when needles were

sterilisedChang, 2011, p73, Norris, 2001, p132


Management of Broken needle

oNever insert needles to the root of the

handle

o If the needle is close to the surface,

press down surrounding tissue to

expose it further

oRemove with forceps

Chang, 2011, p73


Managing a Broken needle

o Withdrawing broken needle

o When break discovered:

o Remain calm

o Patient kept still

o If broken needle protrudes from skin use tweezers or forceps to extract it

o If just below the surface apply pressure with thumb and index finger to the

skin. If protrudes remove with tweezers

o Do not probe or push the area to expose the needle

o If in deep tissue, must be extracted surgically

o The standard protocol is to circle the site of insertion with an inedible

marking pen

o Immobilise the area

o Arrange for immediate transport to a suitable medical facility for surgical

intervention

Chang, 2011, p73, Norris, 2001, p132



Bleeding and Haematoma

o Always check after needle

removal

o Apply pressure until bleeding

stops or swelling is

reabsorbed

o If swelling persists, apply ice

for a few minutes.

Traditionally, this can be

followed up with moxa or

rubbing the area.Chang, 2011, p74-5

Image: Jen 2009



Pneumothorax

o Avoid deep needling over chest

o Collapse of part or all of a lung due to air

allowed to penetrate into pleural cavity

o Symptoms vary from slight discomfort to severe

dyspnea and shock

o In all cases of suspected pneumothorax call for

medical assistance or ambulance

Chang, 2011, p75-6


Pneumothorax

Image Hellerhoff, 2013

oYes it can happen

oDr Mike Cummings has

over 45 years of practical

experience in acupuncture

oGet the Article here

oSee the video on the next

slide

Cummings et al, 2014,

https://journals.sagepub.com/doi/pdf/10.1136/acupmed-2014-010659


Watch the video

Cummings et al, 2014,


Managing accidents during

acupunctureo Brain and spinal cord:

o When needling between the upper cervical or

beside vertebrae – too deeply or on the wrong

angle

o The danger of the medulla oblongata may be

GV15, GV16, GB20 punctured.

o Signs & Symptoms:

o Convulsions Paralysis

o Coma Severe bleeding

o Post Rx S&S:

o Headache Nausea

o Vomiting Disorientation

Xiaorong, C, 2011, p76, Norris, 2001, p129-30

Image: Nucleus Medical Media Inc, 2015


Points to Practice

o Jing well Points (Include LU11, ST45)

o Shixuan Points (Include PC9 – but you don’t have to do

all 10)

o GV26

o GV20

o KI 1

o ST36

o PC4

o Moxa on Ren 8 with salt

Image: Net Doktor, 2008


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ReferencesCohen, M. M., Smit, D. V., Andrianopoulos, N., Ben-Meir, M., Taylor, D. M., Parker, S. J., … Cameron, P. A. (2017). Acupuncture for

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CMAC221 WK01 Lecture EmergencyAcupuncture · acupuncture will be introduced along with an Introduction to microsystems (ear, hand, face and scalp). Balance (I-Ching) acupuncture will

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