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Regional > CSE'S josh > Flashcards

CSE'S josh Flashcards

1
Q

CSE

currently being used in what sx’s

A
  • orthopedic
  • urological
  • gyn
  • post-op pain
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2
Q

CSE

offers both _____ and ____

A

analgesia

anasthesia

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3
Q

CSE

ehen can it be used

A

any situation where a spinal or epidural is planed

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4
Q

CSE

it offers the quick onset of a _______

wuth the flexability of an _______ catheter for prolonged procedures and/or post op pain

A

spinal

epidural

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5
Q

CSE

most commonly used needle

A

modified touhy with a “black eye”

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6
Q

Label

A
  • Quincke-babcock
  • Pitkin
  • Greene
  • Whiteacre
  • Touhy
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7
Q

CSE

the needle used for CSE is designed to be slightly _____ than the epidural needle used. typically it is what size?

A

longer

4.5 inch spinal needle

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8
Q

Label

A
  1. Cauda Equina
  2. Dura
  3. Ligamentum Flavum
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9
Q

CSE

the other needle used today is what? but not used as much b/c there is a higher incidence of inadvertent dural puncture during placement since it is NOT rounded like the Tuohy

A

straight beveled Crawford

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10
Q

CSE TECH: 2 level

tell me the tech

A
  • epidural cat is inserted 1st and tested so placement is confirmed
  • then spinal is done one or 2 interspaces Below the epidural level
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11
Q

CSE TECH: 2 level

advatages

A

able to test epidural cath prior to injection of spinal

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12
Q

CSE TECH: 2 level

disadvantage

A

trauma and discomfort from multiple level insertion

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13
Q

CSE TECH: Single level

tell me steps

A
  • insert epidural needle at appropriae space
  • then usuing the epidural needls as a guide for the spinal needle
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14
Q

CSE TECH: Single level

advantages

A
  • less tissue trauma
  • less backache
  • less morbidity
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15
Q

CSE TECH: Single level

disadvantage

A
  • inability to test catheter
  • (b/c spinal goes first)
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16
Q

CSE TECH: Single level

once epidural cath is placed, any fluid aspiratedmust be assessed to see if it’s CSF. how can you do this?

A
  • CSF is warm to the touch
  • CSF will form a precipitate if mixed with equal volume of Sodium thiopental
    *
17
Q

CSE TECH: Single level

any injection via the catheter must ONLY BE DONE after what? and you must aspirate every __-__ ccs while giveing epidural doses

A
  • careful and diligent aspiration test
  • 3-5 cc’s
18
Q

CSE TECH: Single level

once spinal is done reassess your epidural needle placement how?

A

LOR

19
Q

CSE TECH: Single level

how should you give the epidural dose and why?

A
  • via catheter rather than the needle
  • b/c your needle is right infornt of the dural hole
20
Q

CSE TECH: Sequential

why was it designed?

A

to minimize hypotension effects

21
Q

CSE TECH: Sequential

tech

A
  • an epidural needle placed at selected IVS
  • low dose (7.5mg hyperbaric Bupivacaine) spinal given
  • epidural is placed quickly as possiable
  • pt placed supine
  • once spinal dose has set and level determined catheter is used to titrate the dose higher
  • (1.5-2ccs per unblocked segment) untill desired effect is determined
22
Q

CSE TECH: Sequential

advantages

A

minimizes hypotensive effect

23
Q

CSE TECH: Sequential

disadvantages

A
  • time concuming
  • using each tech at 1/2 it’s potential
24
Q

CSE:

although suitable for anytime either is used it is particulary suitable for what pt’s

A

obstetric pts

25
Q

CSE:

in OB it was the tech employed to provide the “_____” epidural

A

walking

26
Q

CSE:

the “walking epidural is typically accomplished by using what LA

A

0.0625% bupivacaine

27
Q

CSE: tech and uses

Involves placement of epidural needle where?

A

L3-4 or

L4-5

28
Q

CSE: tech and uses

usually the catheter is activated using _____-____% _____ followed by initiation of an infusion of _____-____% ______ @ __-__ mL/hr (w or w/o opiods)

A
  • 0.125-0.25% bupivacaine
  • 0.0625-0.125% Bupivacaine
  • 10-12 mL/hr
29
Q

Dispite the utility and flexability of the CSE tech, several concerns r/t it’s use exist. What are they

A
  • Ability for the pt to SAFELY ambulate
  • failure to obain SAB
  • Catheter migration
  • Metallic particles
  • PDPH
  • Infection
  • Neuro injury
30
Q

done

A

yaaaa

Regional (24 decks)

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