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A1 > Spinal and epidural lecture > Flashcards

Spinal and epidural lecture Flashcards

1
Q

Vertebrae by columns and number

A

C-7
T-12
L-5
S-5
C-4
33 total

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2
Q

C1 and C2

A

Allow for head rotation at the atlanto axial joint

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3
Q

Parts of the vertebrae

A

Vertebral body
Vertebral foramen
Lamina
Pedicles
Traverse process
Spinous process
Inferior articular process
Superior articular process

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4
Q

Differences in angles between thoracic and lumbar spinous process

A

Thoracic is aiming downwards- 40 degrees of spine
Lumbar is straight and flat- 90 degrees off spine

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5
Q

What are the purposes of the foramina and discs

A

Foramina- spinal nerves exit here
Disc- shock absorber

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6
Q

Landmarks of the spine

A

C7- vertebral prominens
T3- spine of scapula
T7- Inferior angle of Scapula
L1- 10th rib
L4/5- superior iliac crest (Intercristal line/ Tuffier’s line) (it is L5-S2 in infants)
S2- superior iliac spine

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7
Q

What do the ligaments do?

A

Stabilize vertebral column

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8
Q

Ligaments in the spine

A

Supraspinous- C7 to sacrum
Interspinous- between spinous processes
Ligamentum flavium - Trapezoid shaped elastin

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9
Q

Order of ligaments from out to inside

A

SILPA
SIL(epidural, duraPOP, subdural, arachnoid, subarachnoid, pia mater) PA

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10
Q

Epidural borders (cranial, caudal, anterior, lateral, posterior)

A

Cranial- Foramen magnum
Caudal- Sacrococcygeal ligament
Anterior- Posterior longitudinal ligament
Lateral- Vertebral pedicles
Posterior- Ligamentum flavium

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11
Q

What does the epidural space contain?

A

Nerve roots, fat pads, blood vessels (Batsons plexus, can become engorged in pregnant and obese and icnrease likelihood of needle injury)

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12
Q

3 meninges and purpose

A

DAP
Dura- Hardest and thickest collagen
Arachnoid- 2 portions, tightly connected
Pia- flat overlappping cells
Surround and protect spinal cord and CSF

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13
Q

CSF is made of ___ and we have ___

A

99% water
1% proteins, glucose, electrolytes, neurotransmitters
100-160ml in adults

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14
Q

What does the spinal space hold?

A

CSF, nerve roots, spinal cord

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15
Q

Spinal needles

A

Cutting tip- quincke
Pencil tip- sprotte/ whitaker/ pencan
Rounded tip- greene

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16
Q

Epidural needles

A

Come Here Taylor
Crawford- 0 degrees
Hustead- 15 degrees
Tuohy- 30 degrees

17
Q

Midline vs paramedian approach

A

Midline is for lumbar only bc thoracic is too curved, SIL
Paramedian (AKA taylor approach)- lumbar or thoracic, L only, 1cm lateral, cephalad

18
Q

How far in is the epidural space

A

4-6cm

19
Q

What immediate symptom would make u stop a spinal injection

A

Paraesthesia- in a vessel?

20
Q

Spinal vs epidural

A

S-rapid, dense, short
E- slower (20-30 min onset), more hemodynamically stable, analgesia, ERAS, long procedure bc redose

21
Q

Block onset order

A

Sympathetic
pain
Proprioception (middle)
touch/ pressure
Motor

22
Q

Return of function after block order

A

Motor
Touch/ pressure
proprioception (middle)
Pain
Sympathetic

23
Q

What determines spread of spinal vs epidural

A

S- Baricity (most important for hyperbaric), pt position, dose (most important for hypo/isobaric), site of injection
E- volume, level of injection(lumbar spread is cephalad, cervical spread is caudad), dose

24
Q

SNS vs sensory vs motor block levels (spinal and epidural)

A

Spinal- SNS 2-6 above sensory
Sensory- above motor
Epidural- Sensory and sns are the same, 2-4 above motor block

25
Q

Spinal bupivicaine dose

A

8-12mg, increasing dose doesnt increase level or denser block

26
Q

What do epi or phenyl do to blocks?

A

Prolong block by inhibiting vascular absorption

27
Q

What do alpha 2 agonists do to spinals?

A

Analgesia
Bradycardia
HOTN sedation

28
Q

What do opioids do to spinals

A

Post op pain relief
Morphine- 12-24 hours

29
Q

Dermatomes landmarks

A

C6-thumb
C7- 2/3 finger
C8- 4 and 5 finger
T4- nipple line
T6- xyphoid
T10-umbilicus
T12- pubic symphysis
L4- knee

30
Q

Neuraxial anesthesia complications

A

PDPH
Meningitis
SIH HOTN
Cauda equina syndrome
Catheter fragments
Failed spinal
Unilateral block

31
Q

Contraindications to neuraxial anesthesi

A

Refusal
Coagulopathy
IICP
Sepsis
Infection at puncture site
Hypovolemia
Scoliosis, arthritis
Difficult airway
Full stomach

32
Q
A

A1 (125 decks)

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