Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APEX > Regional/Neuraxial > Flashcards

Regional/Neuraxial Flashcards

1
Q

Median nerve function

A

Palmar/ventral: most of palm, all of index, middle fingers, lateral 1/2 of ring finger
Dorsal: Just the tips of index, middle, and lateral 1/2 ring fingers.

SENSORY TEST: pinch index finger
MOTOR TEST: thumb opposition

INJURY: (rare) → reduced sensation over palmar surface of thumb, index, middle, lateral ring finger.
→ from: traumatic antecubital IV placement, carpal tunnel syndrome (only nerve that passes thru carpal tunnel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Axillary nerve function

A

Sensory: lateral aspect of shoulder

Motor: arm ABduction (deltoid contraction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Musculocutaneous nerve function

A

Sensory: pinch lateral aspect of forearm. Supplies most of thumb side of forearm beyond hand. (Think where you put an art line in)

Motor: elbow flexion (biceps contraction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Radial nerve function

A

[Ventral/palmar: thumb]
[[Dorsal:
-thumb
-back of hand
bottom 1/2 of:
—-index, middle, medial part of ring finger
Median/central forearm, elbow, area around biceps]]

Sensory test: pinch the web space between thumb and index finger
Motor test: elbow extension (triceps contaction), wrist + finger extension

INJURY: wrist drop
→ BP cuff too tight, IV pole, UE tourniquet, sheets too tight with arm tucking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ulnar nerve function

A

Supplies: pinky and medial 1/2 ring finger on both sides of hand.

Sensory test: pinch pinky finger
Motor test: pinky finger abduction

Injury: impaired sensation pinky and ring fingers. Chronic = claw hand
most commonly injured peripheral nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Landmarks of interscalene block

A

Clavicular head of SCM
Clavicle
Cricoid cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of interscalene block

A

Phrenic paralysis
→ fine in healthy pts, can be problematic with resp disease

Horner’s syndrome
→ stellate ganglion blockade. indicates success PAM

Inadvertent epidural/spinal
→ If needle directed too medially

Seizure
→ if in vertebral artery, as little as 1mL could cause

C6 neuropathy
→ cramp felt

RLN injury, pneumo (R>L), Bezold Jarisch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Landmarks of supraclavicular block

A

Clavicle, subclavian artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Biggest risk of supraclavicular

A

Pneumothorax
Tall, thin patients at high risk

Block good for all UE cases except shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a good block for a patient with respiratory issues?

A

Infraclavicular. (Cord level)
-Nerves are distant from the neuraxial structures and phrenic nerve, so diaphragmatic paralysis is rare.

However, it’s the most painful, bc needle has to pass thru pec major and pec minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Landmarks of intraclavicular block

A

Coracoid process, clavicle

Works for cases below elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of infraclavicular block

A

Vascular puncture
Pneumo (lower risk than interscalene and Supra)
Painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Unique aspects of infraclavicular block

A
  • Because there is high variability in location of cords, nerve stim is used with ultrasound
  • Also, the nerves appear hyperechoic (bright instead of dark) at this location because there is ↑ amt of connective tissue around the nerve fascicles as they move distal to the extremity.
  • Most painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lumbar plexus

A 
L1-L4 +/-T12
Iliohypogastric, 
Ilioinguinal, 
Genitofemoral, 
Lateral femoral cutaneous, 
Obdurator, 
Femoral

Lateral fem cutaneous, obdurator, and femoral are really the only three you need to understand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sacral plexus

A

L4-S4

Posterior femoral cutaneous, sciatic

Covers all of foot

(Sciatic → Common peroneal → Superficial peroneal, deep peroneal
→ Tibial → Sural, posterior tibial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Coccygeal plexus

A

S4-Co

Pudendal, inferior anal, perianal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tibial nerve

A

-Branch of sciatic
→ SURAL: outer edge of foot
→ POSTERIOR TIBIAL: back of heel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Common peroneal nerve

A

-Branch of sciatic
→ SUPERFICIAL PERONEAL: top of foot, medial ankle
→ DEEP PERONEAL: between 1st two toes
→ COMMON PERONEAL: lateral upper calf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Femoral nerve

→ What’s the main branch?

A

Arises from lumbar plexus (L2-L4)

Sensory: Anterior thigh, front of knee, medial inner thigh.
Motor: sartorius, quads.

→ SAPHENOUS is main branch. Sensory to medial/inner lower leg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Obdurator nerve

A

Arises from lumbar plexus.

Sensory: inner/medial knee
Motor: hip adductors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lateral femoral cutaneous nerve

Posterior femoral cutaneous nerve

A
  • LFC arises from lumbar plexus. Lateral thigh

- PFC arises from sacral plexus. Back of thigh, back of knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sciatic nerve: general and main branches

A

Arises from sacral plexus. Largest nerve in body. Motor to posterior thigh, motor and sensory to most of lower leg via common peroneal and tibial branches.

→ COMMON PERONEAL → superficial peroneal + deep peroneal

→ TIBIAL → sural + posterior tibial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What blocks could you do to foster tolerance of a lower leg tourniquet? What about an arm tourniquet?

A

Lower: sciatic and saphenous

Upper: have to cover in the intercostobrachial nerve (whatever..)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risks of prolonged cross legged injury

A

Superficial peroneal and sural nerve injury

25
Q

Function of each peripheral nerve type

A

A alpha: motor

A beta: pressure

A gamma: muscle tone

A delta: temperature

26
Q

Psoas compartment block (lumbar block)

A

-Targets LFCn, femoral, obdurator
-Useful when neuraxial is C/I and anesthesia to one LE is preferred.
-Has one of the highest complication rates, esp hematoma, and renal capsular injection. Coagulopathy is a CI.
Creates sympathectomy of extremity.

27
Q

How could you provide complete coverage of lower extremity?

A

Femoral + sciatic

28
Q

Structures passed thru during insertion of femoral nerve block

A

2 pops felt

-fascia lata, fascia iliaca

29
Q

Adductor canal block

A

Can be thought of as a femoral nerve block lower down in the thigh, more motor sparing. Good for knee surgery, affects quads less, allows earlier ambulation.

30
Q

Fascia iliaca block

A
  • no need for ultrasound or nerve stim
  • can be used for hip fractures
  • line drawn from pubic tubercule to ASIS = inguinal ligament
  • line divided into thirds, needle insert 1cm caudal to where lateral third meets middle third
  • covers lateral femoral cutaneous and femoral nerve
31
Q

Tibial nerve

A

Inversion, plantar flexion

32
Q

Peroneal nerve

A

Eversion, dorsiflexion

33
Q

Needle insertion tibial ankle block

A

Between medial malleolus and Achilles’ tendon.

→ palpate tibial artery (behind medial malleolus) and insert needle perpendicular to skin, lateral to artery.

34
Q

Sural nerve ankle block insertion point

A

Between lateral malleolus and Achilles’ tendon.

35
Q

Deep peroneal ankle block needle insertion

A

Superior/top portion of ankle. Just medial to DP artery. Ask patient to flex foot against resistance, makes tendons of anterior tibial muscle and long muscles of big toe more visible.

36
Q

Saphenous nerve ankle block needle insertion

A

Anterior aspect of medial malleolus (in front of it). Follows right along saphenous vein. Nerve is superficial to the vein.

37
Q

How many vertebrae of each kind are there?

A
  • C7
  • T12
  • L5
  • S5
  • C4
38
Q

Borders of epidural space

A

Cranial border: foramen magnum
Caudal border: Sacrococcygeal ligament
Anterior border: Posterior longitudinal ligament
Lateral border: Vertebral pedicles
Posterior borders: Ligamentum flavum, vertebral lamina

39
Q

How many spinal nerves are there?

A

31 paired

40
Q

Key dermatomes to know

A 
C6 - thumb
C7 - pointer, middle
C8 - ring, pinky
T4 - nipple
T6 - xiphoid
T10 - umbilicus
T12 - pubic symphisis
41
Q

Primary site of action of spinal anesthesia

A

-Myelinated preganglionic fibers of spinal nerve roots.

42
Q

Things that affect spread of spinal anesthesia

A
  • Baricity
  • Patient position
  • Dose
  • Site of injection
  • Volume, density of CSF (not controllable)
43
Q

Primary determinant of epidural anesthetic spread

A

Volume

44
Q

Differential blockade spread with spinal anesthesia

A

Autonomic blockade 2-6 dermatomes higher than sensory

Sensory block 2 dermatomes higher than motor block

45
Q

Differential spread of epidural anesthesia

A

No autonomic blockade with epidural.

-Sensory block is 2-4 levels higher than motor.

46
Q

Order of onset of peripheral nerve blockade by nerve fiber type

A

B, C, A gamma+A delta, A alpha+beta

47
Q

Classification of peripheral nerves

A

HEAVY:
A alpha: skeletal muscle, motor, proprioception. Fastest.
A beta: touch, pressure. Fast.
MEDIUM:
A gamma: skeletal muscle tone.
A delta: fast pain, temperature, touch.

B: preganglionic ANS. Lightly myelinated.

UNMYELINATED:
C (sympathetic): Postganglionic ANS
C (dorsal root): slow pain, temperature, touch.

48
Q

MS and neuraxial

A

Epidural probably ok. However, spinal may exacerbate symptoms.

49
Q

Specific gravity of CSF

A

1.002-1.009

50
Q

Cutting tip needles

A

Quinke, Pitkin.

Require less force, but higher risk of PDPH.

51
Q

Non cutting tip needles

A

Pencil point: Sprotte, Whitacre, Pencan

Rounded tip: Greene

Require more force, but less risk PDPH.

52
Q

Caudal dosing peds

A

Sacral: 0.5mL/kg

Sacral to low thoracic: 1mL/kg

Sacral to mid thoracic: maybe 1.25mL/kg

Any concentration of bupivicaine, levobupivicaine, or ropivicaine may be used as long as dose does not exceed 2.5mg/kg.

For adult, 12-30mL total. Not doing these on most adults. Whatever.

53
Q

Where does spinal cord end?

A

Ends in a taper as the conus medullaris.

Adult: L1-L2
Infant: L3

54
Q

Where does the subarachnoid space terminate?

A

At the dural sac.

Adult: S2
Infant: S3

55
Q

Triamcinolone epidural administration

A
  • Commonly administered into epidural space to treat pain r/t lumbar disc disease (radiculopathy or nerve root compression)
  • It’s unique because it’s associated w ↑ incidence of skeletal muscle weakness compared to other steroids, also more likely to cause sedation and anorexia
56
Q

Landmarks for caudal block

A

Superior iliac spines and sacral hiatus

Needle is inserted at sacral hiatus

57
Q

S/S epidural abscess

A

Localized back pain, radicular pain, sensory or motor deficits, ultimately paralysis

Can happen a few days after a catheter - hematoma s/s are quick and acute

58
Q

Drugs that prolong block DOA

Drugs that provide supplemental analgesia

A

Epi
Dexamethasone
Dextran

supplemental analgesia: epi, neuraxial opioids, clonidine

APEX (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions