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Su: Sim Lab 2 > 1. Bier Block > Flashcards

1. Bier Block Flashcards

1
Q

BB Advantages

A

bloodless field
easy
fast onset
fast recovery
muscular relaxation
control of anesthesia

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2
Q

BB disadvantages

A

systemic SE
time-limited
uncomfortable

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3
Q

BB indications

A

distal/superficial extremity
- carpal tunnel
- ligament/tendon

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4
Q

BB limitations

A
  • must be inflated 15-20 mins
  • no analgesia once cuff is down
  • short duration (45-60 min)
  • tourniquet pain
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5
Q

BB absolute CI

A
  1. no bupi or ropi
  2. no epi
  3. infection
  4. pt refusal
  5. allergy to local
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6
Q

what drugs can you not use in BB?

A

bupivacaine
ropivacaine
epinephrine

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7
Q

BB relative CI

A
  1. raynauds
  2. beurgers
  3. homozygous sickle cell
  4. ischemic limb
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8
Q

IV LA systemic absorption (fastest to slowest)

A

FASTEST
IV/Arterial
Tracheal/Transmucosal
Intercostal
Paracervical
Epidural/Caudal
Brachial Plexus
Sciatic
Sub Q
SLOWEST

I TIP EB SS

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9
Q

5 factors that slow LA absorption

A
  1. injection site
  2. additives (epi)
  3. high lipid solubility
  4. incr dosage
  5. incr volume of dist
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10
Q

Amide hydrolysis
(Short to long acting)

A

SHORT
Prilocaine
Lidociane
Mepivacaine
Ropivacaine
Bupivacaine
LONG

PLMRB

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11
Q

LA SE

A

Circumoral/tongue numbness
Lightheadedness
Unconsciousness
Seizures
Tinnitus
Eyesight
Respiratory arres

Fibrillation
Urticaria
CV collapse

Muscle twitching
Altered mental state
Slurred speech
Seizure

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12
Q

LAST Symptoms

A
  1. seizure
  2. hypotension
  3. arrhythmias
  4. resp distress
  5. cardiac arrest

SHARC

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13
Q

LAST treatment

A
  1. intralipid
  2. vent support
  3. cardiac support
  4. seizure suppression
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14
Q

intralipid dosing

A

1.5-3 ml/kg

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15
Q

LAST cardiac drugs/dosing

A

10-100 mcg epinephrine

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16
Q

seizure suppression drugs

A

versed
propofol
pentothal

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17
Q

hand/forearm BB dosing

A

3 mg/kg of 0.5% lido

18
Q

cuff below knee BB dosing

A

50 mL of 0.25% lido

19
Q

cuff on thigh BB dosing

A

100 mL of 0.25% lido

20
Q

BB surgical anesthesia

A

5-10 mins

21
Q

BB tourniquet pain

A

20-30 mins

22
Q

in what order do you inflate the cuffs for a BB

A

distal
then
proximal
then deflate distal

23
Q

how long should you monitor pt for LAST after taking down cuff

A

5-10 mins in OR

24
Q

after how long can you take cuff down without stressign about LAST

A

40 mins

25
Q

how long does the cuff have to stay up after injection of LA

A

15-20 mins

26
Q

what can you do if you need to take the cuff down early?

A

bounce the cuff
eval for LAST
deflate cuff
eval for LAST

27
Q

ester metabolism

A

psuedocholinesterase

28
Q

cocaine metabolism

A

liver

29
Q

amide metabolism

A

CYP450 enzymes
liver

30
Q

ester metabolite

A

PABA
(causes anaphylaxis)

31
Q

prilocaine metabolite

A

o-toluine
(methemoglobinemia)

32
Q

which amide has the worst CV symptoms

A

bupivacaine

33
Q

what is similar to PABA

A

methyparaben preservative

34
Q

lidocaine hematology effects

A

decr thrombosis
incr fibrinolysis

35
Q

excessive LA use causes

A

respiratory acidosis

36
Q

intralipid _______ the volume of distribution

A

increases the volume of distribution

37
Q

short LA block drugs

A

chloroprocaine

38
Q

medium LA block drugs

A

lido
mepivacaine
prilocaine

39
Q

long LA block drugs

A

procaine
tetracaine
bupivacaine
ropivacaine

40
Q

what should you inflate the tourniquet to

A

2.5x systolic
or
systolic + 100

41
Q

what can you do if pt complains of tourniquet pain

A

inflate distal cuff
deflate proximal cuff

42
Q

epinephrine contraindications

A

nose
hose
fingers
toes

Su: Sim Lab 2 (18 decks)

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