Regional Flashcards
What nerves need to be blocked for an awake intubation?
Glossopharyngeal (IX) and vagus (X)
What branch of the glossopharyngeal nerve can be blocked (invasive) for awake intubation and how?
Lingual branch; using needle to inject local at the junction of the base of the tongue and the glossopalatine arch (near tonsillar pillars)
What does the glossopharyngeal nerve innervate?
Posterior 1/3 of tongue, the vallecula, and the ant surface of the epiglottis (lingual); walls of the pharynx (pharyngeal); tonsils (tonsillar)
What structures does the internal SLN innervate?
Base of tongue, posterior epiglottis, aryepiglottic fold, arytenoids (internal); cricothyroid muscle (external)
Where is the SLN block performed?
2-4 mm inferior and lateral to the greater cornu of the hyoid bone where it pierces the thyrohyoid membrane
Describe non-invasive SLN block approach
Local-soaked pledgets placed into piriform fossae
What does the RLN innervate? How is it blocked?
Vocal cords, trachea and all muscles of larynx except for cricothyroid; locate cricothyroid membrane and place needle perpendicular to axis of trachea
What do the greater and lesser palatine nerves innervate?
Nasal turbinates and posterior 2/3 of nasal septum
How can the palatine nerves be blocked (non-invasive)?
Local-soaked pledgets passed along upper border of middle turbinate to posterior wall o nasopharynx (origin of both nerves at pterygopalatine ganglion
How can the palatine nerves be blocked (invasive)?
Inject local 1 cm medial to junction of 2nd and 3rd molar (greater palatine foramen into pterygopalatine ganglion fossa)
What does the cricothyroid muscle do?
Tenses the vocal cords (adduct)
Most common symptom of RLN injury?
Hoarseness
Which nerve must be blocked for awake tracheostomy?
RLN
Where does RLN run? Inadvertently blocked?
Between trachea and esophagus; can inadvertently be blocked with stellate ganglion block
What happens with bilateral RLN injury?
Rapid, severe respiratory obstruction
How is brachial plexus divided?
Roots, trunks, divisions, cords, branches
What roots are in brachial plexus?
Anterior primary divisions of C5-C8, T1; fuse above first rib
How many trunks are a part of the brachial plexus? Where do they form?
3 trunks at level of first rib
What are divisions?
Each trunk divides into anterior and posterior divisions
What happens at the cord level?
Plexus recombined to for 3 cords - medial, lateral, posterior in relation to ____ artery
Which cord(s) give rise to flexor nerves?
Medial and lateral
Which cord(s) give rise to extensor nerves?
Posterior
What gives rise to the median nerve?
Lateral and medial cord
What gives rise to the ulnar nerve?
Medial cord
What gives rise to the musculocutaneous nerve?
Lateral cord
What gives rise to the axillary nerve?
Posterior cord
What gives rise to the radial nerve?
Posterior cord -> axillary nerve -> radial nerve
Where is median nerve? (axillary)
Above axillary artery
Where is ulnar nerve? (axillary)
Below axillary artery
Where is axillary vein? (axillary)
Anterior to axillary artery
Where is radial nerve? (axillary)
Posterior and inferior to axillary artery
Where is interscalene block performed?
At C6, level of the cricoid cartilage between anterior and middle scalenes
