Module 10 Flashcards
1
Q
Where’s nipple line
A
T4
2
Q
The thoracic blocks are the
A
Anterior cutaneous muscles, coming out of spine
3
Q
Where’s Xiphoid process
A
T6
4
Q
Where’s unbilicus
A
T10
5
Q
Where is pubis
A
T12
6
Q
In the thoracic region, muscles are
A
B low a rib
7
Q
What is the order of vasculature
A
Vein
Artery
Nerve
8
Q
Looking at the back, from lateral to medial, name the muscle
A
QL & Erector Spinae
9
Q
The illiohypogastric & ilioinguinal nerves innervate the
A
Lower abdomen (L1)
10
Q
ASIS is
A
Anterior, superior & iliac spine (hip bone)
11
Q
Pectoralis block is your
A
Chest wall blocks
12
Q
Rectus block is placed in the
A
Rectus Sheath under the Rectus abdominus muscle
13
Q
A good TAP block is placed between
A
Internal Oblique & Transverse Abdominis
14
Q
A QL 1 block is placed in between
A
Where the transverse abdominis ends & QL muscle begins (tip of QL muscle)
15
Q
How many CCs for Rectus block & its indication
A
20mL
Abdominal wall
16
Q
Which is superior? QL OR TAP
A
QL
17
Q
How is sensation distributed in the subcostal area
A
A nerve is midaxillay & anterior
18
Q
Sympathetic chain ganglia lies (conductor of visceral pain)
A
Is along the the vagus nerve in the psoas muscle laying on the body of the vertebrae
19
Q
ASIS on ultrasound will look
A
Black
20
Q
What are the 2 types of TAP blocks that can be performed
A
Subcostal (under ribs) or Midaxillary
21
Q
TAP will take away
A
Cutaneous not visceral
22
Q
QL 1 is at the
A
Tip of QL
23
Q
QL 2 is
A
On top of QL muscle
24
Q
QL 3 is
A
In between QL & Psoas
25
With QL 3, your needle comes
Posterior to anterior
26
How many CCs for PEC 1 block?
PEC2?
PEC 1: 10-15mL
PEC 2: 20mL
27
What are the indications for a PEC block
Breast Surgery
Thoracotomy
Rib fractures
28
First rib is located
Under the clavicle
29
The 4th rib will be
Where you inject local for PEC block, once ultrasound probe is moved more lateral, near axillary
Touch rib with needle
30
When placing a PEC block, how should LA be placed
20 near midaxillary & pull back needle to inject in between major & minor
31
For serratus block, where is the LA injected
Between serratus anterior & Latissimus dorsi ( muscle on top) or between serratus and intercostal
32
From top to bottom, name the muscle for serratus block
Latissimus Dorsi
Serratus
Intercostal
33
An erector spinae block should provide coverage
4 dermatomes below & 4 dermatomes above
34
For an erector spinae block, where should you needle be placed
On the tip of transverse process
35
Rhomboid for the erector spinae block ends at
T5
36
The chest is innervated by dermatomes
T1-T6 ventral rami
37
The abdomen is innervated by
T6-L1
38
At the thoracic level, the ventral spinal
Nerves enter the
Neurovascular bundle with an artery & vein
39
Much of the brachial plexus innervates
Muscles of the chest
40
In the abdomen, the ventral rami travel in the
Intercostal plane between the transverse abdominis & internal oblique
41
The lateral cutaneous branch pierces the
External oblique & supplies the skin of the flanks & back
42
The lateral cutaneous nerves enter the
Rectus sheath & terminate in the Rectus abdominis muscle
43
The Rectus abdominis muscle & Rectus sheath extend from the
Xyphoid to the Pubis
44
The ilioinguinal & iliohhpogastric nerves arise from the
Lumbar plexus
45
The iliohypogastric nerve enters the
Transverse abdominal plane at the anterior iliac crest & innervates the skin over the hypo gastric & gluteal region
46
The ilioinguinal nerve enters the
Transverse abdominis plane close to the anterior superior iliac spine as it courses to the inguinal canal
47
The ilioinguinal nerve innervates the lower
Abdominal wall, upper thigh & pubic areas
48
Specific nerve blocks can forfeit
Visceral pain coverage
49
The Rectus abdominis block covers the ventral rami of
T7 to T12
50
LA in the Rectus abdominis will spread
3-4 dermatome levels, providing somatic pain relief of the anterior abdominal wall, medial to the injection site
51
Where does the nerve pierce in the Rectus block
The Rectus sheath & Rectus abdominis block covers
52
Where is the nerve for a Rectus block
The Rectus sheath & Rectus abdominis
53
Where is the LA placed for a Rectus sheath block
The posterior Rectus sheath by going through the Rectus abdominis; this should left the Rectus muscle
54
55
The posterior aponeurosis of the transverse & internal oblique muscle fuse &
Attach to the thoracolumbar fascia
56
In regards to the transverse abdominis plexus, there is an
Upper & lower plexus, so blockage of the bride abdomen is needed for anesthesia
57
The subcostal TAP covers
T6-T9
58
The midaxillary TAP covers
T10-T11
59
The midaxillary TAP will not cover
Ilioinguinal & iliohypogastric nerves arise
60
The midaxillary block will not cover
Ilioinguinal & iliohypogastric nerves
61
The anterior or subcostal TAP is placed
At the lower margin of the rib cage
62
In regards to the anterior/subcostal block, the target for LA is
Between the posterior Rectus sheath & transverse abdominis muscle
63
Where is ultrasound placed for a subcostal block
Midaxillary line between the subcostal margin & the iliac Crest ( target is in between internal oblique & transverse abdominis) when LATERAL
64
For the posterior TAP block, the target is
The most posterior end of the transverse abdominis plane. The goal is the visualize the posterior beak & to place LA just above
65
QL1 block is placed
On the anterior tip of the QL muscle between the QL and the Rectus abdominis muscle
66
The QL2 block is placed
Above the QL muscle between the QL & Erector Spinae or Latissimus Dorsi
67
The QL3/transmasculine block is placed
Below the muscle, above the psoas major
68
The QL3 block is
The closest to the spinal route, which means better pain control
69
A major advantage of the QL1 block over a TAP is
Blocking of the L1 region
70
With the QL 3 block, the needle is placed
Posterior to Anterior
71
With which block will you see shamrock sign
QL3
72
What kind of anesthetic is used for PEC block
Large, dilute volume
73
Which nerve are important for PEC blocks
Long thoracic
Lateral pectoral
Medial pectoral
Intercostal
Thoracodorsal
74
Which muscles are important for PEC block
Pec major/minor
Serratus
Subclavius
75
What is useful with the intercostal block
It is blocked with PEC block & can be used for tourniquet pain in the upper arm
Same nerve used for ring block
76
The thoracoacromial artery is in between the
Pec major & minor
77
Why isn’t important to visualize the needle for PEC block
You are cm away from pleura
78
The PEC 1 block is placed between
PEC minor & major
79
PEC 2 block is placed between
PEC minor & serratus
80
The goal of the erector spinae block is to
Inject local so that it will flow around & bathe the ventral/ anterior root and possibly the dorsal/posterior root ganglion
81
When performing the erector spinae block at T5 or above, the
Rhomboid Major is see
82
The lower border of the scapula corresponds to
T7
