Extra Practice for Regional Final Flashcards
What does in plane refer too?
In plane refers to the needle being inserted and followed in the same plane as the ultrasound beam, this allows for visualization of the entire needle during the procedure***
What does out of plane refer too?
Out of plane refers to the needle being inserted perpendicular to the plane of the beam. This is a more difficult approach since you can only see a portion of the needle shaft .**
What is Short Axis?
In terms of the vessel, short axis is looking at a transection view of the vessel
For the Femoral block, what are the two “pops” that are felt?
Fascia Lata then Fascia iliaca
Out of the two “pops” for the femoral block, thish is the distinct “tough one”
Fascia Iliaca
The Femoral nerve turns into what Nerve?
Saphenous nerve
What does the saphenous nerve innervate?
The medial aspect of the lower leg
The two terminal branches of the sciatic nerve:
Tibial and Common Peroneal
Two terminal branches of the common peroneal:
Superficial and Deep Peroneal
Terminal branches of the Tibial Nerve:
Sural and Deep Tibial
When you do a popliteal block, what nerve will you miss if you want to do surgery on the lower leg?
the Saphenous
What is Horners Syndrome is?
Horners Syndrome is: PTOSIS, MIOSIS AND ANHIDROSIS
What are the two blocks that you can expect horners syndrome??
Horners happens with Interscalene (always) and Supraclavicular (lesser)
What two blocks can have the potential for a penumothorax?
Infraclavicular and Supraclavicular block
Which block is contraindicated in a person with compromised respiratory?
Interscalene block because you involve the phrenic nerve
Oculocardiac Reflex is parasympathetic response that causes a decrease in heart rate of 20% below baseline values and Can induce arrhythmias including V-fib. How do you treat it if this occurs?
Stopping Manipulation of the eye and an anticholinergic: Atropine or Glyco
What are the major complications of intercoastal blocks?
hemothorax, pneumo, kylothorax and LA Toxicity
Why is there a high probability of LA in an intercoastal block?
There is high probability of LA Toxicity because it is a highly vascularized region
If you want to do shoulder surgery with a Supraclavicular block will this be enough from an anesthetic stand point?
No you will also need to have some other type of anesthesia on top of the block, you will not be able to do the procedure with the block alone.
If you wanted to arm surgery and you do an interscalene block, what nerve will you miss?
Ulnar nerve
What block can you do if you wanted to do shoulder surgery and MAC anesthesia?
Interscalene block
Doing an axillary block, what part of the brachial plexus will you block?
Branches
Doing an interscalene block, what part of the brachial plexus will you block?
Roots
Which nerve gives us the ability to speak?
Recurrent laryngeal nerve
What is the motor response for the ulnar nerve?
Stimulation of the ulnar nerve causes 5th digit flexion and opposition and ulnar wrist deviation.
What is the motor response for the Median nerve?
The median nerve when stimulated produces opposition of the thumb and little finger, pronation of the forearm and flexion of the wrist.
Should you add epinephrine to digital blocks so you have the ability of the LA to last longer?
No! No epinephrine to distal extremity blocks
What are the roots of the brachial plexus?
C4-T1
What does it mean when something is HYPERechoic?
Structure reflects most sound waves
Structure appears white on screen
What does it mean when something is HYPOechoic?
Echofree
Structure allows most sound waves through
Structure appears black on screen
How does the brachial plexus look appear on US when you scan from the post proximal and work your way most distally?
Hypo or hyper?
Hyperechoic
What is an acoustic shadow?
Bone is hyperechoic and appears as bright with an acoustic shadow below, this shadow is caused by the inability of the ultrasound waves to penetrate the structures below.
What is acoustic impedance?
Acoustic impedance- the resistance to sound transmission through a medium. (almost like fiction)
When ultrasound passes through two very different materials the majority of it is reflected.
This happens between air and the body, meaning that most ultrasound waves never enter the body.
To prevent this large difference in impedance a coupling medium (gel) is used between the air and the skin.
Which structure has the highest impedance?
Bone
What is the motor response when you stimulate the common peroneal nerve?
Common peroneal nerve stimulation causes dorsiflexion and eversion (injury = FOOT DROP)
What is the motor response when you stimulate the tibial nerve?
Tibial nerve stimulation Plantar flexion and inversion
Oculocardiac Reflex is mediated by the parasympathetic nervous system. What are the nerves involved?
Trigeminal-Vagal reflex***
-Efferent pathway for the oculocardiac reflex
Ophthalmic nerve is afferent to Trigeminal nerve
Vagas efferent to SA node
Which block has a lower risk for an intrathecal injection?
Retrobulbar or Peribulbar?
Retrobilbar
How much LA would you use for a Retrobulbar block?
Aspirate, then inject 2 to 5ml of LA.
How much LA would you use for a Peribulbar block?
Aspirate, then Inject 8-10ml of LA.
The gag reflex is mediated by which nerve?
The gag reflex is mediated by the GlossophArynGeal Nerve
Complications associated with retrobulabar blocks? Which is the most common one?
Complications associated with retrobulabar blocks – Most common is Superficial or retrobulbar hemorrhage.
Normal Intraocular Pressure?
Intraocular Pressure 10 to 22mm Hg
Intraocular pressure is determined by what?
Intraocular pressure is determined by aqueous humor dynamics - The most important determinant of IOP is aqueous humor production and elimination balance
