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Apex > 8 Regional > Flashcards

8 Regional Flashcards

1
Q

Borders of epidural space

A

Foramen magnum to sacrococcygeal lig, posterior long lig, vertebral pedicle, lig Flavum and vertebral lamina

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2
Q

What is batsons plexus

A

Epidural venous veins that drain blood from SC. No valves, pass through anterior and lateral epidural space

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3
Q

Where subarachnoid space ends in adult and in infant

A

S2 Adult S3 infant

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4
Q

Structure that correlates w dural sac

A

Superior iliac spines

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5
Q

Interspace: conus medullaris, tuffiers line (correlates w what), dural sac, sacral hiatus/coccygeal lig

A

L1, L4-5/iliac crests, S2, S5

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6
Q

Dermatomes: C6, C7, C8

A

Thumb, 2nd and 3rd digits, 4th and 5th digits

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7
Q

Dermatomes: T4, T6, T10

A

Nipple line, xiphoid, umbilicus

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8
Q

Dermatomes: T12, L4

A

Pubic symphysis, anterior knee

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9
Q

Factors that affect spread in spinal

A

Baricity of LA, pt position, dose, injection site

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10
Q

Factors that do NOT affect spread in spinal

A

Barbotage, inc abd p, speed of injection, bevel orientation, addition of vasoconstrictor, weight, gender

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11
Q

Spinal anesthesia: where autonomic and sensory blocks occur in relation

A

Autonomic block= 2-6 dermatomes higher than sensory. Sensory= 2 dermatomes higher than motor

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12
Q

Epidural anesthesia: sensory block in relation to motor

A

2-4 dermatomes higher

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13
Q

CV effects of neuraxial anesthesia, reflex

A

Decrease venous return, CO, and BP. Bezold jarisch

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14
Q

Cns fx neuraxial

A

Dec sensory input to RAS leading to drowsiness

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15
Q

When at risk for bleeding w neuraxial

A

Plt <100k, or PT/aPTT/bleeding time 2x nml value

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16
Q

Contraindications to neuraxial

A

Bleeding risk, inc ICP, sepsis, infec at site, valve lesions w fixed SV (as/ms/HOCM), scoliosis/fusion/OA, difficult a/w, full stomach, peripheral neuropathy, mult sclerosis

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17
Q

Conditions that inc specific gravity

A

Hyperglycemia, uremia, high protein content, adv age, colder temp

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18
Q

Conditions that dec sp gravity. Nml csf sp grav

A

Liver dis, jaundice, warmer temp. 1.002-.009

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19
Q

Only solution in water that is hyperbaric, why

A

Procaine 10%, contains a lot of molecules

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20
Q

Hypobaric: what happens if sitting or supine after injection

A

If sitting will go to brain. If supine will go to lumbar region

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21
Q

Needle angle of epidural needles

A

Crawford 0, hustead 15, touhy 30

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22
Q

Contraindications to caudal anes: absolute

A

Spina bifida, meningomyelocele of sacrum, meningitis

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23
Q

Relative contraindications to caudal anes

A

Pilonidal cyst, abn superficial landmarks, hydrocephalus, IC tumor, degenerative neuropathy

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24
Q

Landmarks to caudal

A

Superior iliac spines and sacral hiatus

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25
Q

Positions for caudal anes

A

Lateral pos w top leg flexed (Simms pos) or prone w frog legs

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26
Q

Additives to caudal anes

A

Epi 1:200,000 or clonidine 1 mcg/kg

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27
Q

Caudal block dosing: sacral peds v adult

A

0.5 ml/kg or 12-15 ml in adult

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28
Q

Caudal block dosing: sacral to t10 peds v adult, to mid thoracic

A

T10: 1 ml/kg peds 20-30 ml adult. To mid thoracic 1.25 ml/kg peds, n/a in adults

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29
Q

Most to least lipophilic to hydrophobic opioids neuraxial

A

Sufent, fent, demerol, dilaudid, morphine

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30
Q

Most common SE neuraxial opioids. Other 3

A

Most common is pruritis. Other= resp dep, Nv, urine ret

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31
Q

How neuraxial opioids cause pruritis, tx

A

Stim of opioid receptors in trigeminal nucleus. Not by mast cells. Narcan will work, Benadryl wont

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32
Q

Hydrophilic opioid v lipophilic fx w resp dep

A

Hydrophilic= early <6h or late 6-12 h. Lipophilic= only early

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33
Q

What reduces efficacy or epidural opioids

A

2 chlorprocaine

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34
Q

How long to wait before doing block w glyco IIB/A antagonists: itrofiban, eptifibatide, abciximab

A

Hold 8 hrs, 8 hrs, hold 1-2 days

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35
Q

How long to wait before block w plavix or ticlid

A

Plavix 7 days, ticlid 14 days

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36
Q

How long to wait for block/after block/after indwelling catheter removal w iv heparin

A

Before block 2-4hr. After block 1 hr. After indwelling removed 2-4 hours

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37
Q

LMWH (lovenox, -Parin ending) how long to wait before placing if once or twice daily. How long before removing indwelling cath. How long after cath removed or after single shot block

A

Before: once wait 12h, twice wait 24h. Before removing: 12h. After removal: 2h. After single shot: once daily hold 6-8h, twice hold 24h

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38
Q

Warfarin: how long to wait before block placement, when can remove catheter

A

Hold 5 days. Can remove if INR <1.5

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39
Q

Thrombolytic implication on neuraxial

A

Absolute contraindication (tpa, alteplase, etc)

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40
Q

Where is conus medullaris

A

Adult l1-2, infant l3

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41
Q

Dural sac: what it is, where it is

A

Where subarachnoid space ends, S2 adult s3 infant

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42
Q

Cauda equina syndrome: cause, what inc risk, s/s

A

Neurotoxicity, inc conc of LA. 5% lido and spinal micro catheters. Bowel and bladder dysfunc, sensory deficit, weakness, paralysis

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43
Q

Transient neuro symptoms: cause, inc risk, doesnt inc risk

A

Pt positioning/sciatic nerve stretch/muscle spasm. Inc: lido, lithotomy, knee arthrosc. Doesn’t: early amb, LA conc, baricity, glucose conc

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44
Q

TNS: s/s

A

Back and butt pain radiating to legs. Develops 6-36h and lasts 1-7 days

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45
Q

Where SC ends in infant, highest point that you can do a spinal in them

A

L3. Highest= L4

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46
Q

Which nerve roots most resistant to fx of LAs

A

L5 and S1. Largest spinal nerves

47
Q

After spinal recovery what comes back first to last

A

Motor, touch, sharp pain, temp

48
Q

Order of being anesthetizzed in spinal

A

Pre gang sns, temp, pin prick, touch, motor

49
Q

2 complications more common in spinal anes over epidural

A

Meningitis and cauda equina syndrome

50
Q

2 complic more common after epidural than spinal

A

Epidural abscess, traumatic spinal cord injury, and spinal hematoma

51
Q

Best method of decontam for neuraxial

A

Chlorhexidine and isopropyl alcohol

52
Q

Brachial plexus: roots, trunks

A

Roots: c5-t1. Trunks: superior, middle, inferior

53
Q

Brachial plexus: cords, branches

A

Cords: lateral, posterior, medial. Branches: musculocutaneous, axillary, median, radial, ulnar

54
Q

Roots that contribute to each trunk

A

C5-6= superior. C7= middle. C8-t1= inferior

55
Q

Roots with corresponding branches

A

C5-7/lat cord/musculocutaneous. C5-6/posterior/axillary. C5-t1/lateral and medial/median. C5-t1/posterior/radial. C8-t1/medial/ulnar

56
Q

Sensory and motor test: axillary

A

Pinch lateral shoulder, arm abduction

57
Q

Sensory and motor test: musculocutaneous

A

Pinch lateral FA, elbow flexion

58
Q

Sensory and motor test: median

A

Pinch index finger. Thumb opposition

59
Q

Sensory and motor test: radial

A

Pinch web between thumb and index finger.elbow extension, wrist and finger extension

60
Q

Sensory and motor test: ulnar

A

Pinch pinky, pink abduction

61
Q

Acceptable nerve twitch responses during interscalene block

A

Deltoid abduction, pec internal rotation, biceps flexion, tricep extension, any twitch of hand/forearm

62
Q

Acceptable v unacceptable twitch responses in supraclavicular block

A

Acceptable: finger or wrist flexion or extension. Unacceptable: shoulder, biceps, or triceps (suggests upper or middle trunk)

63
Q

Landmarks in supraclavicular

A

Clavicle and subclavian artery

64
Q

Acceptable twitch response w infraclavicular block

A

Triceps or any muscle below the elbow

65
Q

Area most likely to not get enough anesthesia after an axillary block w transarterial technique

A

Lateral fa

66
Q

Risk with ulnar nerve block, avoid median block in who

A

Vol too high can compress ulnar and lead to ischemic injury. Median nerve- avoid if carpal tunnel syndrome

67
Q

Bier block: steps from seeing arm to removing esmarch in inflating tourniquet

A

Elevate arm 1-2 min, wrap esmarch, inflate distal, inflate proximal, deflate distal, remove esmarch

68
Q

Vol and conc LA for bier block

A

50 ml 0.5% lido

69
Q

Bier block tourniquet pressure goal

A

250 or 100 above SBP

70
Q

When tourniquet pain may occur. How long tourniquet needs to be up after iv regional. Max tourniquet inflation time

A

45-60 min. 20 min. 2 hrs

71
Q

How to change out tourniquet if pain after bier block

A

Inflate distal cuff, deflate proximal cuff

72
Q

If 20-40 min since LA injection how to deflate cuff

A

Deflate, immeadiately reinflate, then deflate after 1 min

73
Q

Tourniquet pressure and vol: leg, calf

A

Leg= larger vol, p 350-400. Calf: same p and vol

74
Q

Lumbar plexus: what it derives from, nerves that come off of it/pneumonic

A

L1-4. I (iliohypogastric) invariably (ilioinguinal) get (genitofemoral) lazy (lat fem cutaneous) on (obturator) Friday’s (fem)

75
Q

How to remember lumbar plexus which nerves come from where, mnemonic

A

2 from 1 (I and I from L1), 2 from 2 (G and L from L2. G= L1+2, l= L2+3) and 2 from 3 (O and F from L2,3,4)

76
Q

Sacral plexus: roots and what comes off from it (including ankle)

A

L4-S4. Post fem cutaneous and sciatic —> com per (sup per and deep per) + tibial (post tib). Com per and tibial converge into sural

77
Q

Coccygeal plexus roots and branches from it

A

S4-co. Pudendal, inf anal, perineal

78
Q

Lumbar plexus gives sensory and motor info where

A

Motor and sensory to anterior thigh. Sensory to medial aspect of lower leg below knee

79
Q

Sensory and motor info from lat fem cutaneous and roots

A

L2-3, no motor, sensory to lateral thigh

80
Q

Femoral roots, important branch, sensory and motor info

A

L2-4. Saphenous. Motor; anterior branch= sartorius, posterior branch= quadriceps. Sensory= ant thigh

81
Q

Obturator: branches, injured when, sensory and motor info

A

L2-4. Pelvic sx. Motor to hip adductors. Sensory to distal inner thigh and pt of hip

82
Q

Sacral plexus: where it originates from. Two pts of it

A

L4-5 and s1-4. Sciatic nerve and posterior fem cutaneous

83
Q

Sciatic nerve roots, sensory, motor info

A

L4-S3. Motor to posterior thigh, motor and sensory to most of lower leg and foot by tibial and common peroneal nerves

84
Q

Post fem cutaneous roots, sensory, motor info

A

S1-3. Sensory to posterior thigh

85
Q

Psoas compartment block hits which nerves

A

Another word for lumbar plexus. Lat fem cutaneous, femoral (and saphenous), obturator

86
Q

Landmarks for psoas block

A

Spinous processes, iliac crests, PSIS. Needle goes 3 cm caudad from L4 and 5 cm lateral from midline

87
Q

Potential complications psoas block, contraindication to it

A

Sympathectomy of one or both legs. Retro hematoma, renal injection. Contra: coagulopathy

88
Q

Borders of fem triangle

A

Sartorius muscle (lateral), adductor longus (medial), ingluinal ligament (superior)

89
Q

Structures inside fem triangle medial to lateral

A

VAN

90
Q

Fascia iliaca block: where LA deposited, layers traversed w needle

A

Inferior to fascia iiliaca superior to ilipsoas. Needle thru fascia lata then iliaca

91
Q

How to inc tolerance of an upper leg tourniquet

A

3 in 1 block or sciatic and a psoas compartment block

92
Q

Sensory and motor from saphenous nerve

A

No Motor. Sensory to medial knee and down the lower leg

93
Q

What does sciatic nerve innervate (muscle wise)

A

Biceps femoris, semitendinosus, semimembranosus

94
Q

Sciatic nerve arises from which roots, which nerves does it consist of

A

L4-5 and S1-3. Tibial and peroneal nerves

95
Q

Stim of tibial nerve in popliteal fossa causes what

A

Plantar flexion and inversion of foot

96
Q

Part of foot that it covers: tibial n, sural n, sup peroneal n, deep peroneal n

A

Tibia= heel. Sural= lateral foot. Sup per= dorsum of foot. Deep per= space b/w 1st and 2nd toe

97
Q

Ankle block nerves, which ones pure sensory

A

Sup per, sural, saphenous, tibial, DP. All S’s= pure sensory

98
Q

Motor func of tibial and DP

A

Tibial= plantar flexion and inversion. DP= Eversion and dorsiflexion

99
Q

Sural nerve: where it is in ankle block, what it provides sensation to

A

Behind lateral malleolus. Sensation to posterior heel and sole of foot and pt of Achilles above ankle

100
Q

Sup per nerve: where it is in ankle block, sensation to where

A

Anterior to lateral malleolus. Dorsum of foot

101
Q

Dep per nerve: where it is in block, sensory to where

A

In between dorsalis pedis a and tibialis anterior tendon of foot. Skin on lateral side of hallux, medial side of second toe

102
Q

Saphenous nerve: sensory to where, where it is in ankle block

A

Medial aspect of lower leg below the knee. Between midpoint of distal tibia and medial malleolus

103
Q

Terminal branches of plexus, pneumonic

A

MARMU, mcn, ax, radial, median, u temp lunar

104
Q

How many RTDCB

A

5 C5-T1, 3, 6, 3, 5

105
Q

Which nerves supplied by medial and lateral cords. Which nerves supplied by posterior

A

Med/lat: median, ulnar, musculocutaneous. Posterior: radial and axillary

106
Q

If pt c/o sensation in anterolateral forearm which block most likely performed

A

Axillary

107
Q

Which block has highest incidence of chylothorax

A

Infraclavicular

108
Q

Where do roots become trunks

A

Lateral border of scalenes

109
Q

Where do trunks become divisions

A

Under clavicle, over 1st rib

110
Q

Where to divisions become cords

A

Under pec minor

111
Q

Where do cords become terminal branches

A

Axilla

112
Q

Which segments of brachial plexus targeted by: interscalene, supraclavicular, infraclavicular, axillary

A

Interscalene: roots. Supra: trunks and divisions. Infra: cords. Axillary: branches

113
Q

Blockade of which nerve will enhance tolerance of an upper arm tourniquet

A

Intercostobrachial

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