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AAN2 > Class 10 Upper Extremity Blocks > Flashcards

Class 10 Upper Extremity Blocks Flashcards

1
Q

Where does the positive (red) and negative (black) ends of the nerve stimulator go?

A
  • Positive = patient

- Negatie = needle

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2
Q

What procedures can a Superficial Cervical Block be used for?

A
  • Superficial neck, shoulder, thyroid

- Carotids

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3
Q

Where should a Superficial Cervical Block be placed?

A
  • midpoint between C6 and mastoid

- Fan block on Posterior border of SCM

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4
Q

What complications can be found with any regional block?

A
  • Infection
  • Hematoma
  • LA toxicity
  • Nerve injury
  • Pneumo
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5
Q

What complications are related to just Superficial Cervical Block?

A
  • Phrenic nerve block
  • Subararchoid or epidural
  • TIA
  • RLN block
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6
Q

What are the indications for the Interscalene Block?

A
  • Shoulder and Shoulder joint
  • Lateral 2/3 of clavical
  • proximal humerous
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7
Q

With an Interscalene Block the arm and forearm will likely not be covered, this is due to which nerve not having and adequate block?

A

-Ulnar

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8
Q

Where should the needle be inserted for an Interscalene Block?

A

-Just behind the SCM in the scalene groove at C6 level.

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9
Q

When using a stimulator for an interscalene block, how far should you advance the needle?

A

-Until parasthesia is felt below the shoulder

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10
Q

During an Interscalene Block, parasthesia at the shoulder could indicate the needle is where?

A

-Suprascapular nerve

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11
Q

The mAmp goal of a stimulator is what? What does stimulation at 0.2 indicate?

A
  • 0.4

- Intraneural

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12
Q

What are some Interscalene Block specific complications?

A
  • Spinal or epidural
  • Intervertebral injection
  • Phrenic nerve block
  • Horner’s syndrome
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13
Q

What are indications for a Supraclavicular Block?

A
  • Any surgery of the UE not involving the shoulder

- Excellent for hand and elbow

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14
Q

Why are bilateral Supraclavicular Block not a good idea?

A

-Possible respiratory emergency from bilateral phrenic nerve blocks

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15
Q

When stimulating the Supraclavicular Block, what are you looking for?

A

-Finger flex or extend.

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16
Q

What runs with the brachial plexus lower in the interscalene triangle?

A

-Subclavian artery

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17
Q

Where is the needle place for a Supraclavicular Block?

A

-One inch lateral to the SCM insertion to the clavicle

18
Q

How is the needle inserted on a Supraclavicular Block?

A
  • Angled caudally

- No deeper than and inch

19
Q

What is the preferred technique for a Supraclavicular Block?

A

-ultrasound to avoid pneumo and subclavian

20
Q

Which brachial plexus block has highest risk of pneumo?

A

-Supraclavicular Block

21
Q

What are the indications for an Infraclavicular Block?

A

-Any arm surgery up to but not including the shoulder

22
Q

What is the main contraindication for a Infraclavicular Block? Why?

A
  • Coagulation

- difficult to place pressure on vascular bundle

23
Q

At what level of the brachial plexus does the Infraclavicular Block work?

A

Cord

24
Q

Where is the needle inserted for a Infraclavicular Block?

A
  • 2cm medial and 2cm inferior of the coracoid process
  • 90 degree angle
  • 4-4.5 cm deep
25
Q

What are the indications for an axillary block?

A

-Surgery of the forearm, wrist, or hand

26
Q

When considering an axillary block what 3 nerves run with the axillary artery? and which exits high in the axilla?

A
  • Radial, medial, Ulnar

- Musculocutaneous (may not get coverage)

27
Q

Where should the needle be inserted for an axillary block?

A

-After axillary artery is palpated high in axilla, needle is inserted just above or below the pulse.

28
Q

What block can be used if as a supplement to an axillary block or if axillary block failed to anesthestize the ulnar nerve?

A

-High/mid humeral

29
Q

At the high/mid humeral block level where are the median and ulnar nerves? Musculocutaneous? Radial?

A
  • Median and Ulnar = with axillary artery
  • Musculocutaneous = under bicep
  • Radial = posterior to humerous
30
Q

At the wrist level where would you find the median nerve?

A

-Between palmaris longus tendon and fexorcarpi radialis trndon

31
Q

At the wrist level where would you find the radial nerve?

A

Medial aspect of brachioradialis muscle

32
Q

At the wrist level where would you find the ulnar nerve?

A

Between ulnar artery and tendon of lexor carpi ulnaris

33
Q

How would you block the radial nerve at the wrist?

A
  • 5ml proximal to the radial styloid

- 5ml superior to the radial bone

34
Q

Where would you place a block of the ulnar nerve at the wrist?

A
  • Needle under the tendon of flexor carpi just above ulnar styloid
  • At ulnar styloid inject dorsally toward radioulnar joint
35
Q

Where would you place a block of the median nerve at the wrist?

A

-between tendons of palmaris longus and flexor carpi radialis

36
Q

What must you cautious of with wrist blocks?

A

-intraneural injections (not much room for nerve movement)

37
Q

Where do finger nerves run?

A

-ventrolateral aspect of the finger

38
Q

What are some rare complications of a digit block?

A
  • Vascular insufficiency

- Gangrene

39
Q

What should not e used with digit block and why?

A
  • Epi

- constrict blood supply to finger

40
Q

What three nerves should be blocked to help with tourniquet pain?

A
  • Intercostobrachial
  • Medial Brachial Cutaneous
  • Medial Antebrachial cutaneous

AAN2 (11 decks)

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