Brainscape's Knowledge GenomeTM

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


See full index

6901 > Spinal & Epidural > Flashcards

Spinal & Epidural Flashcards

1
Q

spine anatomy

A 
cervical = 7
thoracic = 12
lumbar = 5
sacral = 5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

components of the vertebrae

A
  • vertebral body
  • pedicle x2
  • transverse process x2
  • lamina x2
  • spinous process
  • superior articulating process x2
  • inferior articulating process x2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what do the articular processes make?

A
  • zygapophyseal joints

- when stacked make the intervertebral foramina

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

spinal cord termination

A
  • adults: L1-L2

- children: L3

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

ligaments of the spinal column

A
  • supraspinous: joins apexes of spinous process, major ligament in cervical and thoracic
  • interspinous: thin, joins spinous process
  • ligamentum flavum: helps maintain posture, 3-5 mm, yellow color
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

membranes of the spinal column

A
  • dura: outermost, thick, protection
  • arachnoid: thin, closely associated with dura
  • pia: thin, directly covers the spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

average lumbar AP distance of epidural space

A

5 mm

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

epidural space

A
  • runs entire length of spine
  • segmented but interconnected
  • contains: blood vessels, fat, lymphatics, nerve roots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

spinal blood supply arteries

A
  • one anterior spinal artery: anterior 2/3 of cord, from vertebral artery
  • two posterior spinal arteries: posterior 1/3 of cord, from cerebellar arteries
  • segmental spinal arteries: artery of adamkiewicz, lower anterior 2/3 of cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

spinal blood supply veins

A
  • 3 anterior spinal veins
  • 3 posterior spinal veins

-communicate with epidural veins

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

specific gravity of CSF

A

1.004-1.009

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

absolute contraindications to spinal anesthesia (3)

A
  • patient refusal or inability to remain still
  • increased ICP
  • localized sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

relative contraindications to spinal anesthesia (6)

A
  • previous spinal surgery
  • aortic stenosis
  • hypovolemia
  • thromboprophylaxis
  • coagulopathies
  • infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

differential blockade

A
  • sympathetic: 2 dermatomes above sensory
  • sensory: 2 dermatomes above motor
  • motor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

block level - epidural versus spinal

A

epidural: more volume moves block higher
spinal: moves based on specific gravity of drug

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

spinal blockade mechanism of action

A
  • primary: spinal roots

- secondary: spinal cord, brain

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

baricity

A

-the ratio of the local anesthetic to the CSF specific gravity

  • hyperbaric > 1.015, add glucose
  • normobaric = 1, NS or CSF
  • hypobaric < 0.999, add water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

factors that control spread of local anesthetic (4)

A
  • dose
  • baricity
  • patient position
  • injection site
19
Q

spinal - cardiovascular effects

A
  • sympathetic fibers arise from T5-L1
  • sympathetic cardioaccelerator fibers arise from T1-T4
  • increased arterial dilation, venous pooling
  • decreased SVR, preload
20
Q

bainbridge reflex

A
  • unopposed vagal tone slows the heart rate

- cardioaccelerator fibers arise from T1-T4

21
Q

spinal - cardiovascular treatments

A
  • fluids
  • alpha or beta agonists
  • serotonin antagonist
  • atropine (if high spinal)
22
Q

spinal - respiratory effects

A
  • loss of accessory muscles, perception of breathing
  • decreased vital capacity
  • impaired cough
  • phrenic nerve (C3-C5)
23
Q

spinal - other effects (GI, stress, thermoregulation)

A
  • GI: unopposed vagal tone, increased peristalsis, relaxed spincters
  • decreased thermoregulation
  • decreased stress response
24
Q

total spinal symptoms

A
  • restlessness
  • hypotension
  • bradycardia
  • apnea
25
Q

epidural test dose

A
  • 3-5 mL 1.5% lidocaine with 1:200,000 epinephrine

- rules out intrathecal or intravascular placement

26
Q

needle gauge - spinal versus epidural

A
  • spinal: 25-29

- epidural: 17-18

27
Q

factors affecting prevalence of PDPH

A
  • needle size
  • cutting versus *pencil tip
  • bevel direction
28
Q

PDPH treatment

A
  • blood patch
  • sphenopalatine ganglion block
  • caffeine, fluids, rest
29
Q

PDPH symptoms

A
  • headache
  • light sensitivity
  • N/V
30
Q

cauda equina syndrome

A
  • persistent paralysis of the nerves of the cauda equina: LE weakness, bowel/bladder
  • associated with microcatheters/small needles (removed from market), repeat dosing of hyperbaric local anesthetics
31
Q

transient neurological syndrome symptoms

A
  • pain in butt, lower limbs

- bowel/bladder dysfunction

32
Q

transient neurological syndrome treatment

A
  • usually spontaneously resolves

- NSAIDs

33
Q

epidural catheters must be removed after _____

A

96 hours

34
Q

epidural or spinal hematoma treatment

A
  • neuro checks

- referral for rapid decompression, <8 hours after symptoms present

35
Q

cutting needle

A

-quinke

36
Q

pencil needle

A
  • spotte, whitacre, pencan

- side port for injection

37
Q

epidural needle

A

-touhy, crawford, weiss

38
Q

epidural equipment

A
  • needle
  • catheter
  • loss of resistance syringe
39
Q

distance to thread epidural catheter

A

-3-5 cm - need to add to distance from epidural space

40
Q

Touffier’s Line

A
  • intercristal line
  • top of iliac crests
  • intersects around L4
41
Q

bromage grip

A

-grasp catheter between pointer and thumb on non-dominant hand and brace hand against the back

42
Q

can you withdrawl a catheter back through the needle?

A

NO

43
Q

all local anesthetics must be?

A

preservative free

44
Q

order in which you lose sensations?

A
  • autonomic
  • temperature
  • pain
  • touch
  • pressure
  • motor
  • vibration
  • proprioception

6901 (18 decks)

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