hypertension Flashcards
1
Q
22 year old presents for ORIF wrist. BP is 164/92. how do you treat this?
A
- perform focused H&P to identify cause, additional CV RFs, any end-organ damage
- check current therapy
- obtain ECG, electrolytes, BUN, creatinine to evaluate end-organ damage
- if cause unknown, identify potential causes of htn in young adult, pheochromocytoma, hyperthyroidism, coarctation of the aorta, illicit drug use
2
Q
anesthetic plan?
A
axillary block (easy to perform, complete anesthesia at the wrist, low complications)
3
Q
how would you perform?
A
- patient supine
- arm abducted and elbow bent at 90 deg
- prep/drape axillary area in sterile fashion
- ultrasound to identify axillary artery and fascial sheath
- insert 22 g short bevel needle into nerve sheath under US guidance
- aspirate
- inject 15-20 cc local anesthetic
- identify musculocutaneous nerve within the coracobrachialis
- insert needle
- inject 5 cc local
- subcutaneous field block just distal to axilla to block medial brachial cutaneous and intercostalbrachial nerves
4
Q
what complications are a/w axillary block?
A
intravascular injection, hematoma, infection, block failure
5
Q
what nerve is commonly missed?
A
musculocutaneous nerve (motor to biceps, sensory to lateral forearm) because it has already left the sheath at the level of the axilla
