Maverick Modules (17 - 19) Ultrasound SCB, ISB, & ANB Flashcards

1
Q

Ultrasound guided supraclavicular brachial plexus blocks are performed at the level of the _______.

A

Trunks

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2
Q

What landmarks are denoted by 1-5 below?

A
  1. Cricoid Cartilage
  2. Superior Thyroid Notch
  3. Sternocleidomastoid
  4. Puncture site
  5. Vertical Infraclavicular puncture site
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3
Q

What anatomical location procedures is the supraclavicular block appropriate for?

A
  • Humerus
  • Elbow
  • Forearm
  • Wrist
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4
Q

The patient should be positioned _____ with the head slightly _____ for a supraclavicular block.

A

Lateral : Elevated

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5
Q

Where should the probe be placed first for a supraclavicular block?

A

Supraclavicular fossa

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6
Q

What three anatomical structures should be located first aiming one’s probe downward in the supraclavicular fossa?

A
  • 1st rib
  • Subclavian artery
  • Brachial plexus bundle
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7
Q

What structure is usually superior and lateral to the subclavian artery?

A

Brachial Plexus

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8
Q

What type of approach is typically used for a supraclavicular block?

A

In-plane Approach

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9
Q

What nerve might be missed if the corner pocket isn’t anesthetized?

A

Ulnar nerve & it’s distribution

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10
Q

What ultrasound block is best suited for surgeries of the shoulder and upper arm?

A

Interscalene Block (ISB)

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11
Q

Where should the probe be initially placed for an ISB?

A

Supraclavicular Fossa

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12
Q

What structures need to be kept in the middle of your view while positioning for an ISB?

A

C5 nerve
C6 nerve
C7 nerve

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13
Q

A ________ approach is suggested to avoid the jugular vein and carotid artery for an ISB.

A

Posterolateral

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14
Q

Evidence suggests ______ cc’s of local is acceptable for an ISB.
Maverick suggests ______ cc’s.

A

10 - 15 cc’s
15 - 20 cc’s

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15
Q

What technique should be utilized in respiratory compromised patients needing upper arm regional anesthesia?

A

Skip the ISB, do a supraclavicular block

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16
Q

What three technique adjustments can be utilized to help avoid a phrenic nerve block?

A
  • Hybrid SCB/ISB injecting at bundle stack
  • Less LA volume (10-15mls)
  • Lower LA concentration
17
Q

The brachial plexus resides between the _____ and _______.

A

Anterior and Middle scalenes

17
Q

Place a ___________________ block in the lower plexus to avoid phrenic nerve block.

A

Hybrid low volume block

18
Q

The axillary nerve block (ANB) is suitable for what surgeries?

A
  • Lower Forearm
  • Hand
  • ORIF of radius/ulna
19
Q

What nerves might be missed with an ISB that result in poor pain control in the lower extremity?
Which block solves this?

A
  • C8 - T1
  • Axillary Nerve Block
20
Q

What nerve requires care to anesthetize to complete an ANB?

A

Musculocutaneous nerve

21
Q

What patient positioning is necessary for an ANB?

A
22
Q

How many cc’s of LA should be injected around the musculocutaneous nerve?

A

5 cc’s

23
Q

What muscle response would be seen with stimulation of the musculocutaneous nerve?

A

Biceps contraction

24
Q

Would ropivacaine or bupivacaine w/ epi be better as the sole anesthetic for an AV fistula creation?

A

Bupivacaine. Creates a more dense block.

25
Q
A