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Regional 540 - PM > centroneuraxial > Flashcards

centroneuraxial Flashcards

0
Q

how many vertebrae in thoracic

A

12

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1
Q

how many vertebrae in cervical

A

7

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2
Q

how many vertebrae in lumbar

A

5

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3
Q

how many vertebrae in sacral

A

5

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4
Q

how many vertebrae in coccygeal

A

4

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5
Q

what are the high points?

A

L3-L4

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6
Q

what are the low points

A

T4

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7
Q

the spinal cord extends to __ in the adult and __ in the newborn

A

L1 adult

L3 newborn

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8
Q

the lateral approach DOES NOT pass through which two structures?

A

supraspinous and interspinous ligaments

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9
Q

the spinal cord is enlarged in two sections, one is called the cervical enlargement but actually forms the Brachial plexus (from __ to __), the other is the lumbosacral enlargement forms the lumbosacral plexus (from __ to __)

A

brachial plexus C5-T1

lumbosacral L2-S3

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10
Q

name the three meninges from outside in

A

dura
arachnoid
pia

dap

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11
Q

the distance from the skin to epidural space using a midline approach is __ to __ cm, with an average of 5 cm

A

2.5 - 8 cm

a 3.5” epidural needle is 8.9 cm long

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12
Q

the principal site of action for neuraxial block is the __

A

nerve root

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13
Q

scoliosis is a __ curvature

A

lateral

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14
Q

kyphosis is a __ curvature

A

excessive posterior

“hump” in thoracic region

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15
Q

lordosis is __ of the back due to obesity or pregancy

A

hollowing

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16
Q

what level for a c-section?

A

T4

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17
Q

belly button is at level

A

T10

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18
Q

inguinal is at level __

A

T12

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19
Q

what is the first fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?

A

B, autonomic, to blockages.

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20
Q

what is the second fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?

A

type C, pain, 0.4-12 microns, NO myelin, 0.5-2.3 m/s, ++++ sensitive

If I was on Hep “C” precautions “secondary” to a needle stick, even if it only penetrated 0.4-12 microns, I could have “NO” sex for 1/2 to 2.3 years and would have “++++” pain.

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21
Q

what is the third fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?

A

type A, many functions, 2-20 microns, heavy myelin, 12-120 m/s, increasing sensitivity.

Three type A people I know do almost everything from age 2-20, even lifting heavy weights 12-120 pounds with increasing sensitivity

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22
Q

type A alpha

A

proprioception, motor

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23
Q

type A beta

A

touch, pressure

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24
Q

type A gamma

A

muscle spindles

25
Q

type A delta

A

pain, temp

26
Q

how to remember the type A fibers in order

A

I knew the car was motoring too fast, so I first touched then put pressure on the brakes, then muscled it as much as I could, but I crashed and now have a lot of pain and a fever.

27
Q

what happens when you block B fibers?

A

venodilation and hypotension

your Blood pressure drops when you block your B fibers

28
Q

what happens when you block your C and A-delta fibers?

A

loss of pain and temp

remember, if I get a needlestick and am on Hep C precautions, or if I wreck my car, it’s going to be very painful and my temp will go up

29
Q

what happens when you block type A-gamma fibers

A

loss of muscle

remember, you’re muscling the brakes as much as you can to prevent a crash

30
Q

what happens when you block type A-beta fibers

A

touch and pressure

remember, you first touch then apply pressure to the brake

31
Q

what happens when you block type A-alpha fibers

A

loss of motor and proprioception

you “knew” the car was “motoring” too fast

32
Q

where are your cardiac accelerator fibers?

A

T1-T4

profound bradycardia

33
Q

Motor block occurs __ segments __ than sensory block

A

2-3 segments LOWER

34
Q

sympathetic block occurs __ segments __ than sensory block

A

2-6 segments HIGHER

35
Q

INR 1.2-1.5 = __

A

NO GO!!

36
Q

Aspirin and NSAIDs

A

not a problem

37
Q

heparin

A

need normal PTT, can heparinize 1 hour post catheter removal

38
Q

coumadin

A

need INR less than 1.5 to perform or remove

39
Q

report new lower limb weakness, sensory deficit, bladder/bowel dsfxn, back pain

A

IMMEDIATELY

need surgical decompression of hematoma!

40
Q

most common complication?

second most common complication?

A

Backache 1

headache 2

41
Q

etiology of post dural puncture headache

A

decreased CSF drops brain into foramen magnum, stretches meninges and vessels on top, leading to HA

42
Q

treatment for PDPH as evidenced by bilateral FRONTAL pain from eyes posterior to occiput then caudad down neck

A

caffeine, fluids, bed rest, NSAIDs, epidural blood patch, DON’T LET THEM GO HOME!!

43
Q

how to prevent PDPH

A

smallest pencil point needle, bevel sideways, straight in, avoid young or females, don’t dull needle on bone, use weak anesthetic, preferably tetra over bup

44
Q

where would you give an epidural blood patch?

A

one level LOWer because blood will spread rostrally (cephalad)

45
Q

tell me about the intercristal line

A

the plane across the top of the iliac crests, usually intersects L4-L5

46
Q

taylor’s approach- _ cm medial and _ cm caudad to posterior superior iliac spine, angle medially and cephalad 55* toward L5 interspace

A

1

1

47
Q

how much CSF do adults make each day?

A

500 ml

48
Q

normal CSF pressure

A

10-20 cmH2O

49
Q

how much CSF in the subarachnoid space, central canal, and brain at any given time?

how much in spinal canal only?

A

140 ml

30-80 ml

50
Q

spec grav of CSF

A

1.004-1.009

51
Q

HYPERbaric solutions have a spec grav __ than CSF and will thus sink to the lowest point

A

greater than

52
Q

HYPObaric solutions have a spec grav __ than CSF and thus float or rise to the top

A

lower

53
Q

how to make a HYPERbaric solution- dissolve in __, makes a baricity > 1

A

dextrose

54
Q

how to make a HYPObaric solution- dissolve in __ water, makes a baricity < 1

A

sterile

55
Q

how to make an isobaric solution

A

dissolve in CSF or NS

56
Q

Highly protein bound drugs such as __ and __ last longer than those that aren’t like lidocaine

A

tetra and marcaine

57
Q

distribution of local anesthetic in CSF is influenced by 4 things

A

baricity
concentration
position
contour

BeCause Position Counts

58
Q

dysfunction of bowel or bladder, think

A

cauda equina

59
Q

severe back pain think

A

transient neurological symptoms

60
Q

n/v occurs due to unopposed parasympathetic activity and __

A

hyperperistalsis

Regional 540 - PM (8 decks)

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