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Fa: Anatomy 2 > 5. Performing Brachial Plexus Blocks > Flashcards

5. Performing Brachial Plexus Blocks Flashcards

1
Q

interscalene block needle insertion no u/s

A

interscalene groove at level of cricoid (C6)

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2
Q

interscalene block head positioning

A

30 degree to contralateral side

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3
Q

interscalene block probe placement

A

parallel to clavicle
over the lateral head of the sternocleidomastoid
at level of cricoid/thyroid cartilage

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4
Q

where does the brachial plexus lie in the interscalene block

A

in the interscalene groove

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5
Q

what direction is the needle inserted for interscalene block?

A

lateral to medial
in-plane approach

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6
Q

landmark for supraclavicular block

A

subclavian artery

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7
Q

probe placement for supraclavicular block

A

in the supraclavicular fossa
parallel to the superior border of the clavicle
angle toward thorax

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8
Q

what is pulsatile in supraclavicular block

A

subclavian rtery

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9
Q

where is the brachial plexus in relation to the subclavian artery for supraclavicular approach

A

lateral

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10
Q

what moves when the pt is breathing in supraclav block

A

pleura

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11
Q

what should you avoid in supraclav block

A

subclavian artery injection
going below rib

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12
Q

where should you inject in supraclav block

A

lateral to subclavian artery
superior to first rib

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13
Q

how much do you inject supraclav

A

20-30 mL

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14
Q

probe placement infraclav block

A

perpendicular to clavicle
medial to coracoid process

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15
Q

landmarks infraclav

A

axillary artery
axillary vein

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16
Q

needle insertion point infraclav

A

inferior to clavicle
in plane from cephalad aspect

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17
Q

what is the needle inserted through for infraclav?

A

pectoralis major
pectoralis minor

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18
Q

which block requires a more steep needle angle

A

infraclav

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19
Q

where do you inject LA in infraclav

A

U-shape around the axillary artery because its difficult to identify all 3 cords

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20
Q

which block has highest risk of pneumothorax

A

supraclav

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21
Q

which block has highest incidence of phrenic nerve palsy

A

supraclav

22
Q

which block is best with indwelling catheter

A

infraclav due to pectoralis stabilization

23
Q

why is supraclav difficult in obese pts?

A

supraclavicular fat pads

24
Q

why is infraclav difficult in obese pts?

A

deeper nerves

25
Q

which block is best for COPD?

A

infraclav

26
Q

which block has fastest onset?

A

infraclav

27
Q

which block has best visualization

A

supraclav
(more superficial)

28
Q

which block has worse visualization

A

infraclav
(deeper)

29
Q

which block has higher risk of hematoma with accidental vascular puncture?

A

infraclav
(difficult to apply pressure)

30
Q

landmark for axillary block

A

axillary pulse

31
Q

axillary pulse location

A

between biceps/coracobrachialis and triceps muscle

32
Q

axillary block pt positioning

A

supine with arm abducted 90 degrees
head turned toward contralateral side

33
Q

median nerve location

A

median n is superior to pulse

34
Q

ulnar nerve location

A

inferior above the pulse

35
Q

radial nerve location

A

inferior-posterior
just behind pulse

36
Q

neurovascular bundle

A

median, radial, ulnar arteries that lie around the axillary artery

37
Q

which nerve lies outside the neurovascular bundle

A

musculocutaneous

38
Q

musculocutaneous location

A

between biceps and coracobrachialis

39
Q

which nerve do you need u/s for in axillary block

A

musculocutaneous nerve

40
Q

transarterial axillary needle ga

A

22 ga

41
Q

transarterial volume

A

30-40 mL

42
Q

trasarterial axillary injection location

A

posteriorly
or
anteriorly

43
Q

why is an u/s good for axillary blcok

A

decr volume of LA
musculocutaneous can be done

44
Q

probe placement axillary block

A

immediately distal to point where pectoralis major inserts onto humerus

45
Q

landmarks axillary

A

radial, ulnar, median nerves around axillary artery

musculocutaneous nerve between biceps and coracobrachialis

46
Q

where do you inject for axillary

A

injection around each nerve

47
Q

axillary volume

A

5-7mL per injection
== 20 mL total

48
Q

which nerve do you inject first

A

radial nerve

49
Q

why do you inject that nerve first?

A

to avoid displacing structures deepeer, inject posterior to the artery first

50
Q

which nerve is posterior to axillary artery?

A

radial nerve

51
Q

axillary block advantage

A

lower complication rate

52
Q

axillary block disadvantag

A

higher LAST risk
does not block axillary nerve
reqs extra injection for musculocutaneous nerve

Fa: Anatomy 2 (17 decks)

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