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Ultrasound Basics (lecture 1) Flashcards

1
Q

Needle is placed in line with and parallel to the transducer.Both the needle shaft and tip are visualized.

A

IN Plane

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1
Q

3 things necessary to perform safe peripheral block:

A
  1. U/S
  2. Nerve Stimulation
  3. Injection Pressure Monitoring
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2
Q

Needle is placed perpendicular to the transducer.
Needle shaft and tip are visualized as a hyperechoic dot on ultrasound.

A

Out-of-Plane

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3
Q

3 types of regional anesthesia

A
  1. Neuraxial
  2. Peripheral Nerve Block
  3. Intravenous regional Anesthesia (IVRA)
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4
Q

one example of IVRA

A

Bier’s Block

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5
Q

3 types of neuraxial anesthesia

A
  1. spinal
  2. Epidural
  3. Caudal
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6
Q

Types of Peripheral nerve blocks:

A
  1. Upper Limb (Cervical Plexus, Brachial Plexus)
  2. Trunk
  3. Lower Limb (Lumbar Plexus, Sacral Plexus)
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7
Q

List upper limb blocks:

A
  1. Cervical Plexus
  2. Interscalene
  3. Supraclavicular
  4. Infrclavicular
  5. Axillary
  6. Peripheral Nerves
  7. Bier Block
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8
Q

Types of Trunk blocks

A
  1. Paravertebral /ESP/MTP
  2. Pecs
  3. Serratus Anterior
  4. Rectus Sheath
  5. TAP/QL
  6. Ilioinguinal/Iliohypergastric
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9
Q

Types of Lower Limb blocks

A
  1. Fascia Iliaca
  2. Femoral
  3. Adductor Canal
  4. Sciatic (Sub-Gluteal)
  5. Popliteal Sciatic (Tibial/Common Peroneal)
  6. IPACK (Interspace between the Popliteal Artery & the Capsule of the posterior Knee)
  7. Ankle (5 individual nerves)
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10
Q

Ultrasound imaging uses the transmission and reflection of high-frequency ____, ____ waves (“ultrasonic sound” waves) in tissues

A

longitudinal

mechanical

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11
Q

Steps of U/S image formation

A
  1. The electricity is sent to the probe.
  2. The crystals converts electricity into sound waves
  3. The sound waves propagate through tissue
  4. The returning waves hit the crystals which amplify the wave.
  5. This then gives you a 2D image
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12
Q

Example of strong reflection

A

Bone (white dot)

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13
Q

Example of weaker reflections

A

Solid organs (gray dot)

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14
Q

Example of no reflection

A

Full bladder/blood (black dot)

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15
Q

characterised by a signal void behind structures that strongly absorb or reflect ultrasonic waves

A

Acoustic Shadowing

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16
Q
A

Acoustic Shadowing

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17
Q
A

Acoustic Shadowing

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18
Q
A

Enhancement

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19
Q

an area of increased brightness underneath fluid resulting from the lack of impedance when sound waves pass through fluid and increased echoes from underlying structures

IOW, the U/S thinks that it needs to amplify the signal because its first encounter is fluid filled (which elicits no reflections), so everything beyond the fluid will be brighter.

A

Enhancement

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20
Q

Color Doppler mode is intended to add color-coded qualitative information about ____ and ____.

A
  • Velocity
  • Direction of Fluid Motion
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21
Q

Mnemonic for color doppler

A

BART

Blue Away Red Towards (the probe)

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22
Q

What option can you select/utilize on the U/S after turning it on to expedite your on-screen view?

A

choose a preset anatomical selection
(will present a standardized initial image)

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23
Q

High frequency =

A

GOOD resolution/BAD Penetration

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24
Q

Low Frequency =

A

BAD resolution/GOOD penetration

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25
Q

Overall Gain adjusts:

A

brightness uniformly to all depths

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26
Q

Time Gain Compensation (TGC) adjusts:

A

brightness/amplification of echos at different depths

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27
Q

What was adjusted here:

A

GAIN

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28
Q

What was adjusted here:

A

depth

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29
Q

When applied the ____ narrows the effective beam width and in this region lateral resolution is optimised

A

focus

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30
Q

Outside of the focus region the effective beam width is ____ and lateral resolution is reduced

A

wider

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31
Q

What was adjusted hers:

A

Focus

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32
Q

Set the system to the ____ frequency relevant to the depth of your scan

33
Q

Mnemonic for remebering U/S settings

A

Fun Dogs Go Fetch

Frequency, Depth, Gain, Focus

34
Q

Phenomenon: Ultrasound waves are mostly reflected by air, we need to place a layer of gel or liquid between the face of the transducer and the area we wish to scan to form an airtight seal

A

Acoustic Coupling

35
Q

Mnemonic: probe maneuvers

A

PART

Pressure, Alignment, Rotation, Tilt

36
Q

Apply the optimum with the transducer so as not to distort the anatomy (veins)

37
Q

Sliding movement of the probe across the skin to track structures

38
Q

Twisting movement, moving from short axis to long axis views

39
Q

Rocking the probe to optimize the angle of reflection

40
Q

PART photo

41
Q

LA reversibly ____ of excitable membranes

A

decrease the rate of depolarisation and repolarisation

42
Q

LA agents act through ____ channels on neuronal cell membranes and ____ action potentials.

A

sodium
block conduction

43
Q

LA agents ultimately stop the transmission of signals from nerves to the ____.

44
Q

LA agents (amides & esters) are best classified based on ____.

45
Q

Short DOA (30-90 min) LA:

A
  • 2-3% chloroprocaine
  • 1% Prilocaine
46
Q

Medium DOA (4-6 hours) LA:

A
  • 2% Lidocaine
  • 1.5% Mepivicaine
47
Q

Long DOA (>8 hours, usually 12-18) LA:

A
  • 0.5%, 0.25% Bupivicaine
  • 0.2%, 0.5%, 0.75% Ropivicaine
48
Q

Epinephrine effect on LA:

A
  • ↓ absorption
  • ↑ DOA
49
Q

Sodium Bicarb effect on LA:

A
  • ↑pH = ↑ uptake & ↑ onset
50
Q

Clonidine & Opiates effects on LA:

A
  • modifies quality of block
  • ↑ DOA of analgesia 2/2 pain pathway modualtion
51
Q

Dexamethasone (Decadron) effect on LA:

52
Q

Dexmedetomidine (Precedex) effect on LA:

53
Q

Local Anesthetic Agent Table Summary

54
Q

Exparel is liposomal ____.

A

bupivicaine

55
Q

concentration of Exparel

A

13.3 mg/cc

133mg/10cc vial

56
Q

How much additional Bupivicaine HCl can be added to a 10cc vial of Exparel?

A

0.25%: ≤ 30cc

0.5%: ≤ 15cc

75 mg additional

57
Q

6 Complications of Regional Anesthesia

A
  1. Vasovagal Syncope
  2. Methemoglobinemia
  3. LAST
  4. Spinal/Epidural Hematoma
  5. Post-Dural Puncture Headache
  6. Cauda Equina Syndrome
58
Q

Vasovagal Syncope treatment

A
  • Trendelenburg
  • Anticholinergic
  • Compressions (if HR low)
  • Oxygen
  • Reassure Pt
  • Stand back and put bed rails up!

TACO

59
Q

Main LA agent that causes Methemoglobinemia?

A

Prilocaine

60
Q

What happens in MetHgb?

A

Methemoglobin (MetHb) is altered state of hemoglobin (Hb) in which the ferrous (Fe2+) irons of heme are oxidized to the ferric (Fe3+) state. The ferric hemes of MetHb are UNABLE to bind oxygen causing the oxygen dissociation curve to shift left, making it more difficult to release O2 (increasing affinity for O2).

61
Q

MetHgb signs >10%

A

Central cyanosis (4-8 hours after prilocaine adm)

62
Q

MetHgb sign <20%

A
  • asymptomitic (OR)
  • headache
  • fatigue
  • dyspnea
  • lethargy (cerebral ischemia)
63
Q

MetHgb signs >20%

A
  • respiratory depression
  • ALC
  • shock
  • seizures
  • death
64
Q

MetHgb >40%

A

life threatening

65
Q

A life-threatening adverse reaction resulting from local anesthetic reaching significant systemic circulating levels.

A

Local Anesthetic Systemic Toxicity (LAST)

66
Q

(LAST) is rare and almost always occurs within ____ of injection of the local anesthetic.

67
Q

LAST signs:
- what first: CNS or CVS syptoms?

A

CNS usually

68
Q

LAST CNS S&S

A

Circumoral numbness
Tinnitus
Restlessness
Tonic clonic seizures
Decreased consciousness
Apnea

69
Q

LAST CVS S&S

A

Hypertension/Hypotension
Tachycardia/Bradycardia
Conduction defects (Prolonged PR, Prolonged QRS)
Ventricular dysrhythmias
Cardiac arrest

70
Q

LAST Tx:

A
  1. Stop injecting LA
  2. Get Help/Lipid Emulsion if necessary
  3. Airway management (100% O2/AVOID hyperventilation)
  4. Control Seizures: Benzos, AVOID Propofol in hemodynamically compromised
  5. Tx HoTN & Bradycardia
71
Q

Lipid Emulsion Tx >70kg pt:

A
  1. BOLUS 100cc Lipid Emulsion 20%
  2. Lipid Emulsion INF: 200cc over 20 min

slide: INF: 200-250cc over 15-20

72
Q

Lipid Emulsion Tx <70kg pt:

A
  1. BOLUS 1.5cc/kg Lipid Emulsion 20%
  2. Lipid Emulsion INF: 0.25 cc/kg/min (IBW)
73
Q

Lipid Emulsion MAX dose

74
Q

Pt remains unstable after Lipid Emulsion Bolus & INF:

A

Re-BOLUS 1-2x same dose + DOUBLE INF *(do not exceed MAX 12 cc/kg)

*total volume can approach 1L in prolonged resuscitation (>30 min)

75
Q

If cardiovascular event occurs, monitoring should be continued for how long?

A

at least 4-6 hours

76
Q

If CNS event occurs, monitoring should be continued for how long?

A

at least 2 hours

77
Q

LAST checklist chart photo

78
Q

Intralipid (lipid emulsion) table photo

79
Q

Intralipid (lipid emulsion) 20% photo

80
Q

NSU Local Anesthetic Dosages

Ultrasound (3 decks)

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