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GME - Residency > POCUS - Nerve Blocks > Flashcards

POCUS - Nerve Blocks Flashcards

1
Q

The fascia lata is ________ to the fascia iliaca.

A

superficial

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2
Q

The FICNB should be injected ______ the fascia iliaca.

A

below/deep to

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3
Q

The three nerves that need to be blocked in the FICNB are what?

A

Lateral femoral cutaneous neve
Obturator nerve
Femoral nerve

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4
Q

What side effect do you need to keep in mind with FICNBs?

A

LAST (local anesthetic, systemic toxicity)

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5
Q

The antidote for LAST is ___________.

A

intralipids

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6
Q

Before you do an extremity nerve block, always check ________________ beforehand.

A

neuro vascular exam

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7
Q

What dose of buivacaine do you use for FICNB?

A

20-30 mL of 0.25% bupivicaine

2 mg/kg max

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8
Q

What are contraindications for femoral nerve block?

A

Coagulopathy, overlying cellulitis, and multisystem trauma

The multisystem trauma is because people may develop compartment syndrome and if they are numb they cannot report symptom change.

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9
Q

The FICNB is injected _________ to the femoral nerve block.

A

about two inches lateral

The landmark is 1/3 of the way from the ASIS to the pubic symphysis.

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10
Q

What does the superficial cervical plexus block?

A

Th anterolateral neck, submandibular area, earlobe/posterior pinna, and supraclavicular area. It can provide anesthesia for IJ CVCs and clavicle fractures.

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11
Q

The superficial cervical block hits nerves that are between which two muscles?

A

SCM and LSM (levator scapulae muscle)

Linear probe goes transverse at the level of the superior border of the thyroid cartilage with the dot pointed anterior/medial. Slide posterior until you see the LSM and hit the nerves between there.

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12
Q

True or false: the interscalene block numbs the whole arm.

A

False

It numbs shoulder to elbow. The supraclavicular brachial plexus blocks the forearm.

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13
Q

Where do you find the interscalene block?

A

Have the patient look contralateral. With the probe transverse at the level of the cricoid cartilage (so inferior to the superficial cervical block) look for the SCM. The AS is deep to the SCM and posterior to the IJ. The brachial blexus is between the AS and the MS.

Alternatively, you can also start at the clavicle and fan up. First find the supraclavicular brachial plexus (next to the subclavian) and fan back.

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14
Q

The interscalene block needs to be deep to the ______________ fascia.

A

prevertebral

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15
Q

True or false: the SCM is deep to the prevertebral fascia.

A

False

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16
Q

In a view of the interscalene block, how are the nerve roots organized?

A

Top = C5
Bottom = C8

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17
Q

For subclavian brachial plexus blocks, the subclavian artery passes through which of the two scalene muscles?

A

Anterior and middle

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18
Q

In doing a subclavian brachial plexus block, the brachial plexus is ____________ to the subclavian artery. The subclavian artery is ___________ to the first rib.

A

lateral; superficial

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19
Q

The supraclavicular nerve block anesthetizes what?

A

The whole arm – shoulder to hand

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20
Q

What is RAPTIR?

A

Retroclavicular APproach To the Infraclavicular Region

21
Q

The RAPTIR block provides the same anesthesia as the ________________.

A

supraclavicular block

22
Q

Where should your probe be in the RAPTIR block?

A

Linear probe
Sagittal orientation
Distal clavicle
Indicator to the head
Pointing

23
Q

In the RAPTIR block, the axillary vein is __________ to the axillary artery.

A

anterior

24
Q

The RAPTIR block is injected just posterior to ____________.

A

the axillary artery

25
Q

How is the RAPTIR different than the traditional infraclavicular block?

A

The RAPTIR goes under the clavicle to get to the axilla, whereas the traditional infraclavicular block goes over.

26
Q

In doing the axillary nerve block, the axillary nerve will be seen superior to the ___________ artery.

A

posterior circumflex

27
Q

In doing the axillary block, the teres minor is _________ to the teres major.

A

superior

28
Q

What position do you get in for the axillary nerve block?

A

Patient is prone
Linear probe
Sagittal with dot cephalad
Inject needle from cephalad to caudad

29
Q

What position do you get in for the axillary nerve block?

A

Patient is prone
Linear probe
Sagittal with dot cephalad
Inject needle from cephalad to caudad

30
Q

The musculocutaneous nerve runs between which two muscles?

A

Biceps and coracobrachialis

31
Q

The musculocutaneous block innervates which region?

A

Anterior forearm

32
Q

The musculocutaneous block is done how?

A

Arm abducted and externally rotated

Probe transverse on the medial upper arm/distal axilla

Find the nerve beween the biceps and coracobrachialis

33
Q

How do you find the ulnar nerve?

A

Locate it next to the ulnar artery and ulnar styloid and then scroll proximally until you find the split into the superficial and deep branches.

34
Q

What muscle runs just anterior and ulnar to the ulnar nerve?

A

Flexor carpi ulnaris

35
Q

The median nerve lies between which two muscles?

A

Flexor digitorum superficialis and profundis

36
Q

Proximal to the elbow, the median nerve runs parallel to which artery?

A

Brachial

37
Q

The radial nerve is always ____________ to the radial artery.

A

radial

38
Q

In the erector spinae block, you can see what muscles?

A

Superficial to deep:
- Trapezius
- Rhomboid
- Erector spinae
- Intercostal

39
Q

On US, how can you tell the difference between rib and transverse process?

A

Ribs are round, TP is flat

40
Q

The erector spinae block goes between what two landmarks?

A

Transverse process and erector spinae muscle

41
Q

What region is anesthetized by the erector spinae block?

A

Hemithorax region, 3 levels above and 4 levels below the injection

42
Q

What region is anesthetized by the posterior tibial nerve block?

A

Most of the sole of the foot

43
Q

Where do you find the posterior tibial nerve?

A

Posterior to the posterior tibial artery

44
Q

Where do you have the probe for the posterior tibial block?

A

Leg is externally rotated
Probe is a couple cm proximal to the medial malleolus with the dot anterior

45
Q

What is the PENG block?

A

Pericapsular nerve group

46
Q

What does the PENG block anesthetize?

A

Acetabulum and pubic rami

47
Q

Between what two landmarks does the PENG block go?

A

Psoas and ilac crest between ASIS and pubic eminence

48
Q

In doing the suprainguinal nerve block, where does the probe go and what do you see?

A

It goes perpendicular to the ilium.

You see the “bowtie” with the sartorius inferior and the internal oblique superior and the iliacus in the middle.

GME - Residency (112 decks)

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