Anatomy Flashcards
superficial cervical plexus
block
- c1-c4
- ONLY cutaneous blocked
- BLOCK: midpoint of posterior border of SCM
- often block ACCESSORY nn accidentally with it (cn 11)
5 nn of superficial cervical plexus
1-Greater auricular 2-LESSER occipital 3-GREATER occipital 4-transverse cervical 5-supraclavicular
Superior surface of posterior arytenoids
INTERNAL branch of SUPERIOR laryngeal nn
Superior Laryngeal Nerve
-block thru thyrohyoid membrane
- base of epiglottis
- superior portion of cords
- arytenoids
- glottic opening
cricothyroid membrane injection
VOCAL cords block and below (captures recurrent laryngeal)
Recurrent Laryngeal territory
up to vocal cords
Glossopharyngeal territory
- upper epiglottis
- base of tongue
- back of oropharynx
BLOCK: behind tonsillar pillars
(retropharyngeal hematoma, CAROTID receptors afferent pathways…increasing pressure….can get bradycardia!!)
ALL MUSCLES OF AIRWAY INNERVATED BY RECURRENT LARYNGEAL EXCEPT:
cricothyroid mm (external br of SLN)
DOES: TENSOR of vocal cords
Stellate ganglion block in relation to carotids
MEDIAL to carotid pulse ANTERIOR to C6 transverse process
–(80% of people) lowest cervical ganglion is fused with the first thoracic ganglion to form the cervicothoracic (stellate) ganglion
stellate ganglion located:
- anterior to pre vertebral fascia
- medial to carotid sheath
- vertebral artery passes ANTERIOR to ganglion at C7, BUT is posterior to anterior tubercle of C6 (90%)
palpate this to locate C6 level
cricoid cartilage
CHASSAIGNAC’s tubercle is C6 TP….felt just lateral to the cartilage
syndrome get with stellate block
HORNER’s
- ptosis
- miosis
- anhydrosis
THIS DOES NOT IMPLY SYMPATHETIC DENERVATION of arm. only that there’s cephalic sympathetic blockade
MOST common clinical sign of sympathetic blockade with stellate block
INCREASE in skin temp [>50% increase in skin blood flow]
will approximate core temp
vertebral artery originates from?
from subclavian aa
stellate block PROOF
-adrenergic activity confirm PLUS sympathetic cholinergic activity
left SUBCLAVIAN line placement can result in?
chylothorax; thoracic duct compromise
anterior border of the lumbar epidural space?
posterior longitudinal ligament
epidural space borders?
ANTER-Post longitud ligament of vertebral body
LATERAL-pedicles and intervertebral foramina
POSTER- flavum
SUPER-foramen mag
INFER-sacral hiatus
plexus in epidural space?
BATSON venous plexus
out to in: epidural space
- supraspinous lig
- interspinous lig
- ligament FLAV
- epid space
- THRU SPINAL CORD
- posterior spinous ligament
- vertebral body
C7 marker
most prom
T3 marker
scapular spine
T7 marker
inferior angle of scapula
T12 marker
lowest rib
L4 marker
iliac crests
S2 marker
PSIS
which nerve usually missed with inter scalene block?
ulnar
(C8-T1…lowest pocket)
HOW TEST?
-finger abduction
-
axillary block missed what nn?
Musculocutaneous
ACTION:
Brachial plexus nn
C5-C8, T1
ANTERIOR PRIMARY RAMI
Posterior cord become?
radial
and axial
Lateral cord becomes
MC nn
after part of it splits off to join with medial cord to become median nn
medial cord becomes ultimately
ulnar
how many divisions?
6
three after
three poster
where does the MEDIAN nn come from?
lateral and medial cords (coming together after gets branch from medial cord and branch from lateral cord)
nerves in relation to AXILLARY artery?
superior - MEDian
infer - ULNar
poster/lat - RADial
BRACHIAL artery - at elbow….where median nn?
medial to brachial aa
median nn placement at wrist?
- -flexor carpi radialis
- -palmaris longus
ulnar nn to hand supplies
-ulnar side
-ALL mm of hand
[except: thenar eminence; 1st and 2nd lumbrical mm]
where ulnar nn at wrist?
btwn:
- flexor carpi ulunaris
- ulnar aa
- pisiform
ANTERIOR roots to lumbar plexus (go to)
-ultimately converge on OBTURATOR nn
POSTERIOR roots of lumbar plexus (go to)
LFC; fem nn
SACRAL plexus gives two nn
- SCIATIC
- poster cut nn thigh
saphenous nn is ONLY component of distal lower extremity that comes from ____nn
femoral
everything else thru sciatic
Obturator
L3-L4
-medial thigh
anterior br of fem
skin
total anesthesia of knee
obturator, sciatic, AND femoral
BEST test to check sciatic block?
foot inversion
(bc most of sciatic is medial side); although will have plantar flexion too
BORDERS of popliteal fossa?
-MEDIAL: semimembranosus
-LATERAL:
biceps femoris
-POSTER:
gastrocnemius
popliteal fossa arrangement (lateral to medial)
- nerve
- artery
- vein
sural nn vs
poster tib IN RELATION TO ACHILLES
MEDial side - poster tib nn
LAT side - sural nn
