Antecubital Fossa

To reduce deviations in blood pressure measurement in the clinic, the patient and clinician should not talk during blood pressure readings. The measurement arm is supported and positioned at heart level with the blood pressure cuff encircling at least 80% of arm circumference. If a mercury or aneroid device is used, then the palpatory method must be used first to estimate the systolic blood pressure.18 If an automated device is used, this is not necessary. After the patient s cuff is inflated above the systolic pressure, the mercury column should drop at a rate of 2 to 3 mm per second. A stethoscope placed over the brachial artery in the antecubital fossa identifies the first and last audible Korotkoff sounds, which should be taken as systolic and diastolic pressure, respectively. A minimum of two readings at least 1 minute apart are then averaged. If measurements... 

Poor catheter location (dorsum of the hand, antecubital fossa) Inability to communicate symptoms (children, sedated patients, language barrier between patient and nurse)... 

Avoid the dorsum of the hand, antecubital fossa, and limbs with significant lymphedema. 

Local necrosis may occur following perivenous leakage of thiopentone. As median nerve damage has been reported following extravasation in the antecubital fossa, this site is not recommended for administration of thiopentone. If significant extravasation occurs then hyaluronidase should be infiltrated into the affected area to facilitate reabsorption. 

Lidocaine (L) and epinephrine Male and female (5-15) Back, chest, dorsum of hand, antecubital fossa (randomly chosen) IDDS iontophoresis L concentration in plasma and skin reaction Plasma L in all subjects was <10ng/mL irrespective of sites. No erythema or edema from L was found. Erythema associated with the anode appeared to be more prominent at the chest or back. ... 

Bruising in the antecubital fossa is one of the commonest adverse effects of blood donation. The common practice of flexing the arm over a cotton wool ball or swab can aggravate bleeding, and direct compression over the puncture site and elevation of the extended arm is recommended (3). 

Blackmore M. Minimising bruising in the antecubital fossa after venepuncture. BMJ (Clin Res Ed) 1987 295 332. 

The threshold amount of mustard vapor required to produce a skin lesion (erythema) is a Ct of about 200 mg min/m. This varies greatly depending on a number of factors, including temperature, humidity, skin hydration, and body site. Warm, moist areas with thin skin, such as the perineum, external genitalia, axillae, antecubital fossae, and neck are much more sensitive. As stated earlier, a liquid droplet of about 10 pg will produce vesication. About 80% of this 10 pg evaporates and 10% enters the circulation, leaving about 10%, 1 pg, to cause the vesicle. Evaporation of small droplets is rapid and nearly complete in 2-3 min amounts larger than several hundred mithgrams may remain on the skin for several hours (Renshaw, 1946). 

The bell (not the diaphragm) of the stethoscope should be placed on the skin of the antecubital fossa, directly over where the brachial artery is palpated. The stethoscope earpieces should be inserted appropriately. The valve should be closed with the cuff then inflated rapidly to about 30 mm Hg above the estimated SBP from the palpatory method. The value should be opened only slightly to release pressure at a rate of 2 to 3 mm Hg/s. 

The nonspecific appearance of garlic bums has been exploited. Three soldiers applied fresh ground garlic to their lower legs and antecubital fossa to produce an erythematous, vesicular rash in an effort to avoid military duty (Kaplan et al., 1990). 

The telltale sign of [VDA are "track marks in the antecubital fossa, which are produced from the healing of skin abscesses. 

Jordan et al. 1972). In six glutaraldehyde-sensitive subjects a provocative use test with 25% glutaraldehyde on the soles was negative, while testing with 2.5% glutaraldehyde on the antecubital fossae provoked a severe dermatitis within 48 h (Maibach and Prystowsky 1977). It does not cross-react with formaldehyde (JuHLiN and Hansson 1968 Maibach 1975 b). 

Right volar forearm Phase 1 (PI) and Phase 2 (P2) Antecubital fossa Outwards a H2O occl. b Empty control c 0.5% SDS occl. d 1% SDS occl. e 2% SDS occl. Wrist... 

Clinical relevance of a positive patch-test reaction may exist for at least 55-65% of positive results. Strongly positive patch test reactions (2+ or 3+) are more likely to be associated with a positive fragrance history than a weak or doubtful reaction (Frosch et al. 1995b). A positive ROAT (repeated open application test, twice daily application on the antecubital fossa for a maximum of two weeks) (Johansen et al. 1996) with fragrance ingredients makes relevance of the reaction more likely. 

Biceps reflex elicited by tapping the biceps tendon in the antecubital fossa tests primarily C5. 

The site for treatment the antecubital fossae or flex area versus the volar side of forearm... 

Fig. 8.13a,b. Median nerve and brachial artery. Longitudinal gray-scale (a) and color Doppler (b) 12-5 MHz US images over the antecubital fossa demonstrate the normal appearance of the median nerve (white arrows in a) and the brachial artery (open arrows in b). Both lie superficial to the brachialis muscle (hr). Note the humeral capitellum (HC) and the radial head (RH). The inserts at the upper left side of the figures indicate probe positioning... 

The less common tendinitis and partial tears of the distal biceps tendon present with localized pain and tenderness over the antecubital fossa. These conditions usually follow repetitive microtrauma or forceful biceps activation. Pain can be exacerbated during resisted elbow flexion or supination of the hand and is worsened by direct palpation of the tendon. At US, partial tears appear as hypoechoic thickening or thinning of the tendon and as contour... 

Fig. 8.32a,b. Bicipitoradial bursitis, a Longitudinal and b transverse 12-5 MHz US images over the antecubital fossa at level distal to the joint line show fluid distension of the bicipitoradial bursa (asterisks) which almost completely surrounds the adjacent normal distal biceps tendon (T), thus mimicking a tenosynovitis process... 

Fig. 8.33a-d. Calcified bicipitoradial bursitis in a woman with chronic renal failure who presented with a palpable mass in the antecubital fossa and difficulties in pronation, a Photograph shows focal soft-tissue swelling (arrowheads) over the anterior proximal forearm, b Transverse and c longitudinal 12-5 MHz US images reveal extensive hyperechoic deposits (arrows) with faint posterior acoustic shadowing related to calcifications with the bicipitoradial bursa. The bursa exhibits thickened walls and the distal portion of the biceps tendon (T) is completely surrounded by calcifications, d Correlative lateral radiograph shows the bulk of calcifications (arrows) in the antecubital fossa... 

Phototherapy of psoriasis consisting of daily application of crude coal tar combined with ultraviolet radiation is commonly referred to as the Goeckerman treatment. The program employed consists of total-body application of 2—5% crude coal tar in petrolatum in combination with ultraviolet exposure. The coal tar is applied to the entire body, from the neck downwards, with the exception of the intertriginous areas such as axillae, antecubital fossae, and groin. Some patients will tolerate (and even request) application to the face, but the chance of tar conjunctivitis is great. 

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