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Acute Pain Final > Upper Extremities > Flashcards

Upper Extremities Flashcards

1
Q

what mA is used for nerve stimulation technique

A

0-5 mA

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2
Q

what frequency is used for nerve stimulation technique

A

1 or 2 Hz

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3
Q

most practitioners inject local anesthetic when current between ____________ mA results in a motor response

A

0.2 and 0.5

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4
Q

ultrasound technique frequency

A

1-20 MHz

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5
Q

how are nerves best imaged

A

cross-section where they have a characteristic honeycomb appearance

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6
Q

technique most frequently utilized for nerve blocks

A

in-plane, as the entire shaft of the needle can be visualized as it approaches the target nerve and navigates surrounding structures.

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7
Q
A

in plane

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8
Q
A

out of plane

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9
Q

what determines block effects

A

total drug mass (DOSE) not the concentration

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10
Q

what forms the brachial plexus

A

brachial plexus is formed by the union of the anterior primary divisions (ventral rami) of the fifth through the eighth cervical spinal nerves (C5–C8) and the first thoracic spinal nerve (T1).

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11
Q

the lateral cord gives off the lateral branch of the median nerve and terminates as

A

the musculocutaneous nerve

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12
Q

the medial cord gives off the medial branch of the median nerve and terminates as

A

the ulnar nerve

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13
Q

the posterior cord gives off the axillary nerve and terminates as

A

the radial nerve

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14
Q

what block are used for shoulder and proximal humerus procedures

A

interscalene

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15
Q

surgeries distal to the mid humerus can be anesthetized via which 3 blocks

A

supraclavicular, infraclavicular, axillary

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16
Q

An interscalene brachial plexus block is indicated for procedures involving

A

the shoulder and upper arm

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17
Q

roots most densely blocked with interscalene

A

C5 to C7

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18
Q

cutaneous branch of C3 and C4

A

supraclavicular

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19
Q

what bilateral block is ABSOLUTELY contraindicated and why

A

Bilateral interscalene blocks are absolutely contraindicated. Hemidiaphragmatic paresis may result in dyspnea, hypercapnia, and hypoxemia

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20
Q

horner syndrome 3 symptoms

A

myosis, ptosis, anhidrosis

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21
Q

if the recurrent laryngeal nerve is blocked patients may experience

A

hoarseness

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22
Q

As little as ____________ mL of local anesthetic delivered into the vertebral artery may induce a seizure.

A

1

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23
Q

The brachial plexus passes between the anterior and middle scalene muscles at the level of

A

the cricoid cartilage, or C6

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24
Q

The external jugular vein often crosses the interscalene groove at the level of

A

the cricoid cartilage.

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25
Q

If surgical anesthesia is desired for the entire shoulder, the ____________ must usually be anesthetized separately (2)

A

intercostobrachial (T2) and supraclavicular (C3 and C4)

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26
Q

The brachial plexus at C6 appears most commonly as

A

three hypoechoic circles with hyperechoic borders.

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27
Q

The primary target for local anesthetic admin in an interscalene block should be

A

between the two most superficial nerves (most commonly C5 and C6)

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28
Q

a supraclavicular block offers dense anesthesia of the brachial plexus for surgical procedures

A

at or distal to the elbow

29
Q

the supraclavicular block is not ideal for shoulder surgery unless combined with

A

a suprascapular nerve block.

30
Q

the supraclavicular block commonly spares the ____________ nerve

A

ulnar

31
Q

Nearly half of patients undergoing supraclavicular block will experience

A

ipsilateral phrenic nerve palsy,

32
Q

The brachial plexus appears as

A

multiple hypoechoic disks (sometimes referred to as a cluster of grapes)

33
Q

most important injection location for supraclavicular block

A

the most important injection location is the “corner pocket” between the artery, plexus, and first rib.

34
Q

Brachial plexus block at the level of the cords provides excellent anesthesia for procedures …

A

at, or distal to, the elbow

35
Q

optimal needle positioning for infraclavicular block

A

optimal needle positioning is between the axillary artery and the posterior cord

36
Q

At the lateral border of the pectoralis minor muscle, the cords of the brachial plexus form large terminal branches oriented around

A

the axillary artery

37
Q

what nerves are usually spared with an axillary approach

A

The axillary, musculocutaneous, and medial brachial cutaneous nerves

38
Q

A ____________ technique is more effective for the axillary nerve block because of ____________

A

multiple injection; fascial separation between nerves.

39
Q

The median nerve is derived from

A

the lateral and medial cords of the brachial plexus

40
Q

The median nerve provides the primary motor innervation to

A

the muscles in the anterior forearm responsible for flexing the fingers and wrist (with some contribution from the ulnar nerve) as well as to the thenar muscles

41
Q

the median nerve provides sensory innervation to

A

the hand

42
Q

The ulnar nerve is the continuation of

A

the medial cord of the brachial plexus

43
Q

compression of which nerve results in cubital tunnel syndrome

A

ulnar nerve

44
Q

the terminal branch of the posterior cord of the brachial plexus

A

radial nerve

45
Q

terminal sensory branches of the radial nerve

A

lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm

46
Q

The radial nerve is most easily visualized on ultrasound as

A

a structure consisting of two hypoechoic circles with hyperechoic borders immediately deep to the brachioradialis muscle in the forearm 2 to 3 cm distal to the lateral epicondyle

47
Q

Blocking the ____________ nerve is essential to complete the anesthesia for the forearm and wrist when performing an axillary brachial plexus block.

A

musculocutaneous

48
Q

the most proximal of the major nerves to emerge from the plexus

A

musculocutaneous

49
Q

the musculocutaneous nerve innervates which 2 muscles

A

coracobrachialis and biceps

50
Q

where does the intercostobrachial nerve originate

A

in the upper thorax (T2) and becomes superficial on the medial upper arm

51
Q

what is the intercostobrachial block frequently used for

A

during upper extremity surgeries, the intercostobrachial nerve block is frequently performed as a supplement to brachial plexus blockade for awake upper extremity surgery under regional anesthesia

52
Q

used as the anesthetic for intravenous regional anesthesia

A

lidocaine

53
Q

Blocking the stellate ganglion (cervicothoracic sympathetic block) causes

A

sympathetic blockade of the ipsilateral face and arm, which presents as Horner’s syndrome

54
Q

what nerve is supplied by ALL branches of the brachial plexus

A

median nerve

55
Q

what structure is between the anterior and middle scalene muscles

A

interscalene

56
Q

supraclavicular block has highest complication of ____________

A

pneumothorax

57
Q

median nerve block landmark

A

flexor carpi radialis tendon

58
Q

ulnar nerve block landmark

A

flexor carpi ulnaris tendon

59
Q

infraclavicular blocks at the level of

A

the cords

60
Q

axillary nerve motor and sensory function

A

o Motor: deltoid and teres minor muscles; externally rotate shoulder; abduct arm

o Sensory: lateral side of arm below shoulder

61
Q

radial nerve motor and sensory function

A

o Motor: extension of elbow, wrist, fingers

o Sensory: dorsal radial side of hand; posterior lateral side of arm

62
Q

musculocutaneous nerve motor and sensory function

A

o Motor: flexion at elbow
o Sensory: lateral forearm

63
Q

push

A

radial

64
Q

pull

A

musculocutaneous

65
Q

pinching thumb and pinky

A

ulnar

66
Q

pinching thumb and index

A

median

67
Q

deep cervical plexus block can cause

A

hemidiaphragmatic paralysis

68
Q

ulnar nerve motor and sensory

A

o Motor: wrist flexion; all finger adduction; flexion/opposition of pinky/ring finger towards thumb

o Sensory: pinky and ½ of ring finger

69
Q

median nerve motor and sensory

A

o Motor: forearm flexors and thumb abduction; forearm pronation; wrist flexion; opposition of middle finger, ring finger, and thumb

o Sensory: thumb, pointer finger, middle finger

Acute Pain Final (4 decks)

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