Upper and Lower PNBs Flashcards

1
Q

Blocking this nerve may help allow you to place a tourniquet on the arm of an awake patient

A

Intercostobrachial nerve (Arises from T2 and is blocked with a field block)

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2
Q

Inter scalene targets these roots

A

C5, 6, and 7 (the stoplight)

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3
Q

What does inter scalene block?

A

Blocks the upper trunk! So it’s good for shoulder and upper arm procedures. Not great for lower arm procedures because it blocks the lower roots that innervate the hand and forearm.

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4
Q

The cupola of the lung is higher on which side?

A

Right side

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5
Q

S/S of Horner’s syndrome?

A

Horny Pam!

Ptosis, anhidrosis, and miosis.

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6
Q

As little as ___mL in the vertebral artery can result in sz activity

A

1mL

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7
Q

Horner’s syndrome occurs as a result of what?

A

Blockade of the stellate ganglion (located at C7). Indicates successful block.

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8
Q

Pneumothorax may have occurred if pt complains of

A

Coughing or chest pain during needle insertion or manipulation

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9
Q

Complications of inter scalene block

A
Horner's syndrome
Phrenic Nerve Paralysis
RLN Injury
Pneumothorax
Epidural/Spinal injection
Seizure
Bezold jarisch reflex
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10
Q

What is the Bezold Garish Reflex?

A

Will see bradycardia and hypotension!

Venous pooling results in a profoundly undefiled ventricle. The heart slows to improve diastolic filling.

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11
Q

Doing this pre-op and decrease the risk of BJR

A

Pre-op beta blockade

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12
Q

Supraclavicular is good for

A

Surgeries at or below the elbow

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13
Q

Complications of supraclavicular block

A

Pneumo
Horner’s Syndrome
Subclavian artery injection

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14
Q

Infraclavicular block is good for

A

surgeries below the elbow

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15
Q

Infraclavicular block will block this part of the plexus

A

Cords

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16
Q

Acceptable motor response for infraclavicular block

A

Triceps or anything below the elbow

17
Q

Complications of infraclavicular block

A
  • Vascular puncture (SA and SV are right around the cords here)
  • Pneumo (though lower risk here compared to inter scalene and supraclavicular)
  • More painful to perform because you’re going through pec major and pec minor
18
Q

This block often misses the ulnar nerve

A

Interscalene

19
Q

This block often misses the musculocutaneous nerve

A

Axillary

20
Q

Axillary nerve block is good for

A

surgeries below the elbow

But misses the MC! Make sure you hit that shit up too!

21
Q

Nerves that come from the lumbar, sacral, and coccygeal plexuses

A

Lumber Plexus (Anterior):

  • Femoral
  • Obturator
  • LFC
  • Iliohypogastric
  • Ilioinguinal
  • Genitofemoral

Sacral Plexus (Posterior)

  • Sciatic
  • Posterior femoral, BIIIITTCHHHH

Coccygeal
- Pundendal

22
Q

Lumbar and Sacral Plexus nerve roots

A

Lumbar = L1-4 and sometimes T12

Sacral = L4-S4

23
Q

Sensory and motor innervation of the LFC

A

Sensory: Lateral thigh

Motor: None

24
Q

Sensory and motor innervation of the femoral nerve

A

Sensory: Anterior thigh

Motor:

  • Anterior = Sartorius
  • Posterior = Quads
25
Q

Sensory to the posterior aspect of the thigh is provided by

A

The posterior femoral nerve

26
Q

The sural nerve is composed of branches from these two nerves

A

Tibial and common peroneal (the two major branches of the sciatic)

27
Q

Borders of the femoral triangle

A

It’s a triangle like the SAIL of a ship!

S = Sartorius
A = Adductor longus
IL = Inguinal ligament
28
Q

This branch of the femoral nerve gives rise to the saphenous nerve

A

Posterior branch of the femoral nerve

29
Q

Stimulation of the tibial nerve will cause this motor response

A

Plantar flexion and inversion of the foot

30
Q

What is has more influence on spread in subarachnoid blocks? Volume or dose?

A

Dose.

For epidurals, both volume AND dose matter.

31
Q

What spinal nerve roots are most resistant to LAs?

A

L5 and S1
These are the largest and most resistant spinal nerves.
L5-S1 interspace is the largest interspace in the vertebral column