Peripheral Nerve Stimulator Flashcards
how long does each nerve stimulus last?
0.2 msec
when will a twitch or muscle contraction occur?
if receptors aren’t blocked
what plays a role in preventing stockpiles of Ach inside the nerve from being depleted?
prejunctional Ach receptors
what happens when 100% of the receptors are blocked (profound neuromuscular blockade)?
no muscle contraction occurs
which drug works by binding and encapsulating and taking the muscle relaxant out of the neuromuscular junction
sugammadex
what are the 5 types of nerve stimulation patterns?
- single twitch
- train of four
- tetanus
- post tetanic count
- double burst stimulation
2 types of single twitch nerve stimulation
- 1 Hz
2. 0.1 Hz
what is a 0.1 Hz single twitch nerve stimulation?
1 stimulation per 10 seconds
what is a 1.0 Hz single twitch nerve stimulation?
1 stimulation per second
how many stimuli does TOF deliver and over how long?
4 stimuli (0.2 sec each) over 2 second period (2 Hz)
most painful nerve stimulation
tetanus
what is the stimulation for tetanus?
50-100 Hz over 5 seconds or less
post tetanic count is a ____ tetanus that is applied for ____ seconds followed by a ____ second pause followed by ________ at 1 Hz.
50 Hz; 5 seconds; 3 second ; single twitch stimulation
two short tetanic stimulations separated by a 750 msec pause
double burst stimulation (DBS)
What is the FIRST tetanic stimulation in DBS?
3 impulses at 50 Hz
What is the SECOND tetanic stimulation in DBS?
2 options: 1. two impulses at 50 Hz
2. 3 impulses at 50 Hz
DBS 3,3
3 bursts at 50 Hz
750 msec pause
3 more bursts at 50 Hz
DBS 3,2
3 bursts at 50 Hz
750 msec pause
2 more bursts at 50 Hz
which nerve stimulation has the lowest stimulation frequency (1-10Hz) and longest stimulation duration
single twitch
which nerve stimulation has the faster stimulation frequency (2-100 HZ) but shortest stimulation duration?
TOF and tetanus
when a nerve is stimulated multiple times in a row __ can occur if the pt has a partial neuromuscular block
fade
What does seeing fade mean?
something is causing less Ach to be released from the presynaptic nerve with each subsequent twitch
what does it mean whenever we see that all the twitches have the same strength ( no fade) ?
an equal amount of Ach was being released from the presynaptic nerve on ALL the twitches
what do nondepolarizing muscle relaxants block ?
both presynaptic and postsynaptic Ach receptors
how do stockpiles of Ach get back to normal with a partial neuromuscular block?
the nerve needs to be rested for a short period of time without being stimulated
describe the 4 things that happen the greater degree of muscle paralysis
- higher # of prejunctional receptors that will be blocked
- the lower amt of Ach that’ll be released on subsequent back to back stimuli
- the higher the degree of fade
- the longer the nerve will have to “rest” before stockpiles of presynaptic Ach can be restored
what do depolarizing muscle relaxants block?
postsynaptic Ach receptors
when will you not see fade?
during partial depolarizing Phase I block
why is the twitch height decreased in partial depolarizing phase I block?
postjunctional receptors are still blocked
What are the two things needed for fade to occur?
- there must be a partial neuromuscular nondepolarizing block
- the nerve must be stimulated at a relatively high frequency
what is the gold standard for assessment recovery of NM blockade?
fade
when will a pt for sure be adequately recovered from NM blockade?
when the pt’s fourth twitch is as strong as the first twitch (no fade is present)
what happens during ONSET of partial nondepolarizing block?
twitch height gradually decreases w/ TOF and single twitch stimulation
what happens during ONSET of partial depolarizing block ?
twitch height gradually decreases with both TOF and single twitch but you wont see fade with each individual train of four pattern
when do you see fade during recovery of nondepolarizing block?
fade with TOF (NOT single twitch)
which nerve stimulation cannot differentiate between depolarizing and nondepolarizing block?
single twitch stimulation
which nerve stimulation(s) CAN differentiate between depolarizing and nondepolarizing block?
TOF, tetanus, post tetanic count, and double burst stimulation
when can you see twitches with sux?
during neuromuscular onset using single twitch stimulation
information about quantities (information that can be measured with numbers)
quantitative data
information that cannot measured or info about qualities
qualitative data
traditional nerve stimulators are more ____ (qualitative or quantitative)
qualitative
traditional nerve stimulators (SunMed brand) deliver maximum output current of how much?
70 mA
tetanus in a traditional nerve stimulator (SunMed) brand is ___ Hz.
100
the sun med plus brand you can choose between __ or __ Hz tetanus and has a ____ as an option
50 or 100; double burst stimulation
the StimPod is an example of ___
newer quantitative peripheral nerve stimulator
the StimPod can use which of the following nerve stim?
TOF, double burst, and post tetanic count stimulation
where should the negatively charged electrode be placed to achieve a maximal twitch height?
closest proximity to nerve
for the ULNAR nerve, where should the red and black electrodes be placed?
red should be proximal and black should be distal
for the facial nerve where should the negative electrode be placed?
over the temporal branch of facial nerve; red can be placed on forehead (zygomatic arch good landmark)
no motor units respond
subthreshold stimulus