Spinals Flashcards
Nerve Fiber Anatomy
Order of Blockade: BC-AAA(DBA)
B fiber
C Fiber
A-Delta
A-Beta
A-Alpha
Absolute contraindications
IL-CSI
Increased ICP
Lack of consent
Coagulopathy
Severe hypovolemia
Infection
Relative contraindications
SPUDS-LS
Sepsis
Preexisting neurological deficit
Uncooperative patient
Demyelinating Lesions
Stenotic valvular heart lesions
Left ventricular outflow obstruction
Spinal deformity
Controversial contraindications
PCP-MM
Prior back surgery
complicated surgery
prolonged surgical time
major blood loss
maneuvers that compromise respirations
Oral anticoagulants (3 of them)
name and time
Warfarin (Coumadin): PT/INR normal range or discontinued for 1 week
Rivaroxaban (Xarelto): Discontinued 72 hours prior
Apixaban (Eliquis) : Discontinued 72 hours prior
Antiplatlets
name and time
NSAID: No delay
Clopidogrel (Plavix): Discontinue 5-7 days prior
Standard Unfractionated Heparin
Low-dose SC Heparin (Hep-Lock): Delay 4-6 hours after 5000 units, longer if higher dose
Systemic Heparin: Delay 4-6 hours and correct PTT, wait 1 hour after spinal to re-administer
LMWH
Low-dose LMWH (Lovenox / enoxaparin)[30-40mg per day]: Delay 12 hours from admin
High-Dose LMWH: Delay 24 hours from admin
Barbotage
CSF swirl in hyperbaric medication
Most dependant aspect of spine in supine?
T5-T7
Most non-dependant aspect of spine in supine?
L2-L4
Less Spread of medication
- baracity and pt position dependant
- Needle orifice orientation
1. Taller pt
More Spread of medication
- baracity and pt position dependant
- Needle orifice orientation
1. Higher med temp
2. Faster Inj
3. Decreased CSF volume
Decreased CSF reasons
Extrinsic or Intrinsic (AGATE-K)
Ascities (E)
Gravid Uterus (E)
Advanced Age (I)
Tumor (E)
Engorged Epidural Veins (E)
Kyphosis / Lordosis (E)
Urinary Retention treatment
- Bethanechol
- Prazosin
