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Su: Sim Lab 2 > 31. Epidural > Flashcards

31. Epidural Flashcards

1
Q

epidural space

A

potential space between ligamentaum flavum and dura mater where fluids can collect

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2
Q

epidural space extends ______ to dural sheat

A

posterior
lateral
anterior

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3
Q

contents in epidural space

A

adipose
lymphatics
venous plexus
connective tissue

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4
Q

epidural indications

A

obstetric analgesia
surgical anesthesia
post-op pain control
chronic pain management

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5
Q

cervical epidrual

A

chronic pain steroid injections

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6
Q

thoracic epidural

A

post-op surgical pain

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7
Q

lumbar epidural

A

labor pain

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8
Q

caudal epidural

A

peds

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9
Q

how are epidurals controlled

A

LA dose
LA type
LA concentration
medication
location

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10
Q

dermatomes show

A

cutaneous sensory innervation

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11
Q

epidural CI: absolute

A

infection at site
pt refusal
coagulopathy
severe hypovolemia
incr ICP
aortic/mitral stenosis
sepsis

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12
Q

epidural CI: relative

A

neuro deficit
sepsis
mild stenosis
spinal deformity

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13
Q

what are we concerned about with anticoags and epidurals?

A
  • START/RESTART anti-coag while catheter is in?
  • time to DISCONTINUE anti-coag before REMOVAL of catheter
  • wait time to RESUME anti-coag
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14
Q

rivaroxaban trade name

A

xarelto

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15
Q

apixaban

A

eliquis

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16
Q

clopidogrel trade name

A

plavix

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17
Q

low dose heparin SC trade name

A

enoxaparin

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18
Q

LMWH trade name

A

lovenox

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19
Q

rivaroxaban (xarelto): wait ____ hrs after catheter removal

A

6 hrs

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20
Q

rivaroxaban: wait ____ hrs before removing catheter

A

22-26 hrs

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21
Q

apixaban: wait ____ hrs after cathether removal

A

6 hrs

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22
Q

apixaban: wait ____ hrs before removing catheter

A

26-30 hrs

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23
Q

clopidogrel: wait ___ hrs after catheter removal

A

start immediately

24
Q

clopidogrel is not recommended when

A

catheter in place

25
Q

Low dose heparin: catheter can be removed when

A

4-6 hrs post dose

26
Q

systemic heparin: remove catheter

A

1 hr prior to admin

or

wait 2-4 hrs after admin to remove

27
Q

LMWH: 2x daily dose

A

4 hrs after catheter removal

28
Q

can you give LMWH with catheter in?

A

no

29
Q

LMWH: 1x daily

A

remove cather 12 hrs after last dose

hold next for 4 hrs post removal

29
Q

Cephalad spinous process

A

C7

30
Q

cather too far in

A

one sided block

31
Q

test dose epidural

A

3mL of 1.5% lido with 1:200000 epi

32
Q

initial dose epidural

A

5 mL
- 0.125% bupi
- 2mcg/mL fentanyl

33
Q

susequent doses epidural

A

5 mL 0.25% bupivacaine
2 mL fentanyl
3 mL NS

34
Q

what sensory level are epidural blocking

A

T10-L1

35
Q

C section epidural dose

A

20 mL 2% lido w/5mcg epi
4 mL 4.2% bicarb
2mL fentanyl

** give 5-6 mL of mixture

36
Q

C- section epidural moprhine dose

A

1.5-2mg in 10mL w/saline

37
Q

hip/Lower extremity sx
ob anealgesiua

A

L2-5

38
Q

colectomy
upper abdominal

A

T6-T8

39
Q

throacic

A

T2-T6

40
Q

best choice for pre-incision for post-op pain epidural

A

50-100 mg 1% lidocaine
+
50-100 mcg fentanyl

41
Q

epidurals are ______ dose

A

volume dose

42
Q

spinals are _____ dose

A

concentration dose

43
Q

what makes PDPH better

A

laying down

44
Q

PDPH duration

A

12-72 hrs

45
Q

factors that incr risk of PDPH

A

younger
female
pregnant
connective tissue disorder
smaller habitus
prior PDPH
larger needle
provider inexperience
bevel lateral orientation

46
Q

PDPH treatment: conservative

A

time
lay down
non-opioid analgeiscs
fluids
caffeine (300-500 mg)

47
Q

PDPH treatment: invasive

A

blood patch
sphenopalantine block

48
Q

limit caffein to ____ if breastfeeding a low birth weight or premie

A

200 mg

49
Q

what % of pts respond to blood patch

A

90%

50
Q

what % of pts respond to second blood patch

A

90% of remaining 10%

51
Q

what drug is used for spehnopalantine block

A

4% lido

52
Q

hematoma treatment

A

surgical decompression

53
Q

hematoma occurence

A

immediate

54
Q

abscess occurrence

A

5 days to weeks after insertion

55
Q

how to prevent abscess

A

bacterial filter
less catherter manipulations
replace every 96 hrs

56
Q

sheared catheters can cause

A

abscess

Su: Sim Lab 2 (18 decks)

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