Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Su: Sim Lab 2 > 30. Spinal Anesthesia > Flashcards

30. Spinal Anesthesia Flashcards

1
Q

cervical vertebrae

A

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

thoracic

A

12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

lumbar

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

sacrum

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

coccyx

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

spinal tissue encounter order

A

skin
supraspinous
interspinal
ligamentum flavum
dura matter
subarachnoid space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

adult spinal cord end

A

L1-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

peds spinal cord end

A

L2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does the dural sheath innervate

A

bladder
GU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

conus medullaris

A

end of spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cauda equina

A

nerve fibers extending caudally from spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

filum terminale

A

fibrous tissue that connects conus medullaris to periosteum of coccyx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

faster blockade

A

smaller
myelinated
proximity to injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

easiest to hardest to block

A

autonomic>sensory>motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

spinal can be the primary anesthetic for which cases

A

lower abdominal
inguinal
urogenital
rectal
lower extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

spinal: absolute CI

A

infection
lack of consent
coagulopathy
severe hypovolemia
incr ICP
aortic/mitral stenosis
sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

warfarin: neuraxial

A

normal PT/INR
or
discontinue for 1 wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

rivaroxaban: neuraxial

A

discontinue 72 hrs prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

apixaban: neuraxial

A

discontinue 72 hrs prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

NSAIDS: neuraxial

A

no need to delay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

clopidogrel: neuraxial

A

discontinue 5-7 days prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

clopidogrel AKA

A

plavix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

anticoags

A

warfarin
rivaroxaban
apixaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

anticoags

A

NSAIDS
clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

low-dose SC heparin: neuraxial

A

delay 4-6 hrs after 5000 units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

systemic heparin: neuraxial

A

delay 4-6 hrs and correct PTT

wait 1 hr after neuraxial event to admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

low dose LMWH: neuraxial

A

delay 12 hrs from admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

high dose LMWH: neuraxial

A

delay 24 hrs from admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

when would lateral positioning for a spinal be beneficial?

A

hip fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

spinal kit

A

spinal needle
3mL syringe w/18ga needle
5mL syringe
18g introducer
25g skin local needle
filter tube or needle
0.75% hyperbaric bupivacaine
lidocaine
needle holder
sterile drape
sterila paper towel
iodine w/sponges
gauze
***epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

cutting needle

A

better for calcified ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

pencil point

A

better tactility
less incidence of PDPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

standard spinal needle size

A

25g 3.5”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

a longer needle means

A

longer time for CSF to return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

tuffiers line

A

body of L4
sometimes L4-L5 interspace

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what should you mark on spinal pt

A

superior aspect of inferior spinous process
inferior aspect of superior spinous process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what do you use to localize in spinal

A

25g needle
3mL syringe
1% lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

where should you insert needle for spinal

A

inferior aspect of the interspaceq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

os

A

bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

os shallow

A

midline but need to redirect cephalad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

os deep

A

off midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

heme

A

blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what happens when you pass through the dura

A

pop

44
Q

barbotage

A

CSF swirl when you aspirate CSF into local

45
Q

barbotage only occurs with

A

hyperbaric medication

46
Q

what can happen if you inject air into spinal

A

pnemocephalis

47
Q

paramedian spinal indications

A

severe arthritis
kyphoscoliosis
previous spinal surgery
thoracic epidural placement

48
Q

how do you insert needle for paramedian spinal

A

15 degrees to midline

49
Q

most dependent part of spine

A

T4

50
Q

most non-dependent part of spine

A

L2-L4

51
Q

does the spine have dependent parts when pt is laying in lateral decubitus?

A

no

52
Q

which block is preferrential for sacral nerves

A

saddle block

53
Q

what type of solution is used for saddle block

A

hyperbaric

54
Q

what influences spread of local anesthetic

A

baricity
pt position
orifice orientation
medication temp
faster injection
pt height
CSF volume

55
Q

higher medication temp

A

more spread

56
Q

faster injection

A

more spread

57
Q

taller patient

A

less spread

58
Q

decr CSF volume

A

more spread

59
Q

what causes decreased CSF volume?

A

gravid uterus
ascites
tumor
engorged epidural veins
kyphosis/lordosis
advanced age (**intrinsic)

60
Q

how long after injection of spinal does spread stop?

A

20-25 mins

61
Q

sympathetic blockade travels the most

A

cephalad

62
Q

sensory blockade is

A

2 levels caudal to sympathetic level

63
Q

motor blockade is

A

2 levels caudal to sensory level

64
Q

sympathetic blockade is tested by

A

temperature

65
Q

sensory blockade is tested by

A

pain
light touch

66
Q

T4

A

nipples

67
Q

T10

A

umbilicus

68
Q

typical surgeries that require spinal

A

C section
lower limb
TURP

69
Q

surgery:
esophagus
lung
upper abdomen

A

block up to T1

70
Q

C section

A

block up to T4

71
Q

lower abdominal surgery

A

block up to T6

72
Q

lower limb surgery

A

block up to L1-2

73
Q

cardiac accelerator fibers

A

T1-T4

74
Q

lumbar spinal will result in sympa or parasympa flow

A

uninhibited parasympathetic flow

75
Q

spinal SE: CV

A

hypotension
- N/V
- dizzy
- dyspnea
variable HR

76
Q

spinal CV: treatment

A

fluids
direct alpha antagonist
beta-antagonist

77
Q

what pts dont tolerate fluid well

A

poor pulmonary status
ESRD
CHF

78
Q

spinal SE: respiratory

A

decr coughing

79
Q

minimize respiratory complications from spinal

A

proper positioning
supportive airway measures

80
Q

what should you check if pt says they cant breathe?

A

SpO2 - 100%
hand squeeze
alert/oriented

81
Q

spinal GI SE

A

peristaltic/contracted gut
decr hepatic BF

82
Q

spinal GU SE

A

renal BF mx’d
urinary retention

83
Q

spinal endocrine SE

A

neuroendocrine stress response

84
Q

what causes neuroendocrine stress response

A

somatic and visceral afferents

85
Q

what happens during neuroendocrine stress response

A

release of ACTH, corisol, epi, NE

activates RAAS

86
Q

spinal complications

A

high neural block
cardiac arrest
urinary retention
meningitis/arachnoiditis
TNS
neurologic injury
pruritis
shivering

87
Q

high spinal symptoms

A

unconsciousness
apnea
hypotension

88
Q

total spinal

A

high spinal
cranial nerve blockade
seizures

89
Q

treatment

A

supportive measures
ABC

90
Q

typical pts who go into cardiac arrest during spinal

A

young
healthy

91
Q

cardiac arrest spinal presentation

A

bradycardia
bradyarrythmias
hypotension

92
Q

spinal cardiac arrest treatment

A

HR correction
BP correction
– fix preload/afterload

93
Q

what causes urinary retention

A

afferent muscle block of sacral nerves inhibits bladder constriction

94
Q

what makes urinary retention worse

A

narcotics

95
Q

what treats urinary retention post-spinal

A

time
bethanechol (muscarinic)
prazosin (a1 blocker)
catheter

96
Q

what pts are at a higher risk of meningitis/arachnoiditis

A

epidural or spinal catheters

97
Q

TNS aka

A

transient radicular irritation

98
Q

TNS symptoms

A

back pain radiating to legs w/o sensory or motor deificit

99
Q

primary cause of TNS

A

hyperbaric lidocaine spinal

100
Q

what % of pts get pruirius with a spinal

A

> 30% of pts who get neuraxial opioids

101
Q

treatment for pruritius

A

naloxone
naltrexone
ondansatron
diphenhydramine

102
Q

what % of pts get shivering?

A

55%

103
Q

is shivering more prevalent in spinals or epidurals?

A

epidurals due to larger volume of injectate

104
Q

what reduces shivering

A

neuraxial opioids
active warming

105
Q

Spinal benefits compared to general

A

decr resp complications
decr cardiac complications
less PONV
earlier ambulation
decr DVT
lower infection
better analgesia
faster GI function recovery
cheaper

Su: Sim Lab 2 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions