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Regional 1 > Test 1 UE blocks > Flashcards

Test 1 UE blocks Flashcards

1
Q

Correct twitch for interscalene block

A

Bicep or forearm movement

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2
Q

Infraclavicular block see bicep twitch

A

Too superior

Withdraw and reinsert more caudal

Musculocutaneous nerve

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3
Q

Infraclavicular block see deltoid muscle response

A

Too inferior
Withdraw and angle more superior

Axillary nerve

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4
Q

Interscalene block elevation of scapula

A

Too posterior

Levator scapula muscle- dorsal scapular nerve

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5
Q

Muscles innervated by thoracodorsal nerve

S&M

A

C6,7,8

Latissimus Dorsi

M- extends, adductor, medically rotates humerus
- raises body toward arms when climbing

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6
Q

Thoracodorsal (middle scapular nerve) origins

A

C6,7,8

Posterior Cord

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7
Q

Interscalene block. Diaphragm stimulated

A

Phrenic nerve

Too anterior (between SCM and ASM)

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8
Q

Infraclavicular block see local twitch resembling latissimus

A

Subscapularis muscle

Too deep

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9
Q

Interscalene block. Trapezius movment in neck

A

Accessory nerve

To superior

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10
Q

Muscles innervated by radial nerve

A

Triceps

Extension of arm, wrist, proximal finger joints, supination, thumb abduction

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11
Q

Musculocutaneous nerve contributors

A

C5,6,7

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12
Q

Muscles innervated by suprascapular

S&M

A

Infraspinatus and Supraspinatus

S- internal capsule of shoulder

M- shoulder abduction

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13
Q

Muscles innervated by musculocutaneous nerve

M&S

A

BBC- biceps, brachialis, coracobrachialis

M- flex arm at elbow, supination

S- lateral surface of forearm (via antebrachial cutaneous) (thumb side)

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14
Q

Infraclavicular block stimulation wanted

A

Hand twitch

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15
Q

Infraclavicular block see arm adduction

A

Direct stimulation of pectoralis muscle

Too shallow

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16
Q

Muscles innervated by dorsal scapular nerve

S&M

A

Rhomboid Major and Minor
Levator Scapula

M- raises medial border of scapula up and medial

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17
Q

Muscles innervated by long thoracic nerve

S&M

A

Serratus Anterior

M- pulls medial border to scapula to posterior thoracic wall and stabilizes it
- rotates scapula with abduction of arm above a right angle

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18
Q

Correct placement of axillary block. Twitch want to see

A

Hand twitch

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19
Q

Nerves blocked by deep cervical plexus

A

Lesser Occipital
Greater Auricular
Transverse Cervical
Supraclavicular

Also ansa cervicalis, hypoglossal, accessory nerve portions

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20
Q

Nerves blocked with cervical plexus block

A

Lesser Occipital
Greater Auricular
Transverse Cervical
Supraclavicular

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21
Q

Medial brachial cutaneous nerve innervates

A

Medial upper arm

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22
Q

Medial antebrachial cutaneous nerve innervates

A

Medial forearm

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23
Q

Dorsal scapular nerve origin

A

C5

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24
Q

Phrenic nerve origin

A

C5,6,7

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25
Q

Medial pectoral nerve origin

A

C8,T1

Medial cord

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26
Q

Axillary nerve origin

A

C5,6,7,8,T1

Posterior cord

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27
Q

Radial nerve contributors

A

C5,6,7,8,T1

Posterior cord

28
Q

Median nerve contributors

A

C5,6,7,8,T1

Medial and lateral cords

29
Q

Medial brachial cutaneous nerve origin

A

T1

30
Q

Muscles innervated by lateral pectoral and medial pectoral nerves

A

Pectoralis major and minor

-adduction, medial rotation, flexion of humerus (shoulder joint)

31
Q

Medial pectoral nerve origin

A

C8-T1

32
Q

Lateral pectoral origin

A

C5,6,7

33
Q

Muscles innervated by axillary nerve

S&M

A

Deltoid and teres minor

S- dome of shoulder

M- abduction of arm at shoulder >15 degrees

34
Q

Muscles innervated by ulnar nerve

S&M

A

M- finger adduction and abduction

  • flexion of digit 4&5
  • wrist flexion and adduction

S- skin medial surface of hand (pinky and 1/2 ring finger)

35
Q

Muscles innervated by median nerve

S&M

A

M- thumb flexion and opposition

  • flex digit 2&3
  • wrist flexion, abduction, pronation

S- anterolateral hand (palm thumb to 1/2 ring finger)

36
Q

Medial antebrachial cutaneous nerve origin

A

C8-T1

Medial cord

37
Q

Ulnar nerve contributions

A

C8-T1

38
Q

Long thoracic nerve origin

A

C5,6,7

39
Q

Suprascapular nerve origin

A

C5-6

40
Q

Area of nerves blocked by cervical plexus block

A

Ventral roots of C2,3,4

41
Q

Superficial Cervical plexus block landmark approach

A

Midway between mastoid process and clavicle. Posterior SCM border

C4 level

42
Q

Amt of LA of superior cervical plexus block

A

22G short-bevel needle
0.5% or less bupiv/Ropiv/Marc

5-10ml fan direction

43
Q

Innervates all muscles of larynx

A

Ansa cervicalis

44
Q

Deep cervical plexus landmark approach

A

Line between mastoid process and chassignacs tubercle (cricoid)
Move 1 cm behind that line

1-2cm down is C2

Make contact with cervical transverse process, withdraw 1-2 mm. Aspirate and inject

3-5ml at each level (2,3,4)

45
Q

Nerves missed by interscalene block

A

Ulnar nerve

Median antebrachial

Medial brachial cutaneous nerves

46
Q

Interscalene block

Depth
LA

A

1-3cm

15-20ml

47
Q

Nerves missed by supraclavicular block

A

Suprascapular or dorsal scapular nerves

Corner pocket injection covers ulnar nerve

48
Q

Aka total spinal for arm

A

Supraclavicular

49
Q

Supraclavicular block LA amt

A

20-25ml

6-7 ml corner pocket
10ml sheath
5ml above and medial

50
Q

Infraclavicular cord location

A

Lateral to axillary artery- lateral cord

Below axillary artery- posterior cord

Medial to axillary artery- medial cord (between axillary artery and vein)

51
Q

Relies of horseshoe spread of LA

A

Infraclavicular

52
Q

Infraclavicular depth and LA

A

Deep. 3-5cm

30-40mlLA

53
Q

Axillary block nerves missed

A

Musculocutaneous and axillary nerves

54
Q

Axillary block depth and LA

A

Shallow. 1-2cm

25-30ml for main

RUM block bottom to top

Musculocutaneous nerve is always superior to axillary artery block with 6-8 ml

Intercostobrachial to get antebrachial and medial brachial cutaneous 6-8ml

55
Q

Radial nerve block

A

Lateral aspect and 3-4cm above elbow crease

Hyperchoic on humerus and under tricep

2-3 ml

56
Q

Median nerve block

A

Buried in muscle

Adjacent to brachial artery at elbow

2-3ml

57
Q

Ulnar nerve block

A

Adjacent to ulnar artery

Hyperchoic

2-3ml

Mid forearm

58
Q

Infraspinatus > supraspinatus

Reduced arm abduction and external rotation

A

Suprascapular nerve palsy

59
Q

Thumb externally rotated into plane of palm

A

Median nerve palsy

60
Q

Claw hand of first and second finger

A

Ulnar nerve palsy

61
Q

Shoulder elevated and abducted

Deltoid weakness

A

Axillary nerve palsy

62
Q

Inability to flex at elbow

A

Musculocutaneous nerve palsy

63
Q

Hand drop

A

Radial nerve palsy

64
Q

Winged scapula

A

Dorsal scapular nerve palsy

Rhomboid paralysis

65
Q

S/S horners syndrome

A

Ptosis
Anhydrosis
Nasal congestion
Miosis

66
Q

Sympathetic mediated response without ptosis or miosis

Facial flushing and sweating

A

Harlequin syndrome

67
Q

2 absolute laws of avoiding pleural dome and causing pneumothorax

A

STAY AWAY from medial 1/3 of clavicle

Stay anterior to 1st rib

Regional 1 (8 decks)

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