Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*Anesthesia Concepts 1 > Upper PB > Flashcards

Upper PB Flashcards

0
Q

What are contraindications for regional?

A
  • pt refusal
  • pt cannot cooperate
  • anticoag therapy
  • neurologic complications
  • infection near injection site
  • septicemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

What are advantages for regional anesthesia (peripheral blocks)?

A
  • can avoid general anesthesia: h/o cardiac dz, h/o pulm dz
  • avoid opiates
  • induced sympathectomy = reduced intraop LOB, improved postop perfusion
  • reduced n/v
  • used as preemptive analgesia = reduce postop pain and analgesic requirements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What things are needed for regional anesthesia prep?

A
  • monitors
  • suction
  • means of PPV (ambu, mask, O2)
  • airway (intubation equipment)
  • IV access
  • drugs (emergency meds, anxiolytics, lipids for LA toxicity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the brachial plexus innervate?

A

-all motor function of upper extremity
-almost all sensory of upper extremity
(cervical plexus branches supply post shoulder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the terminal nerves of the brachial plexus and what do they innervate?

A
  1. musculocutaneous
    motor: biceps, brachialis, coracobrachialis; flex FA
    senory: lat mid FA into wrist
  2. axillary
    motor: deltoid, teres minor
    sensory: inf shoulder, lat UA
  3. radial
    motor - triceps, supinator, FA extensors
    sensory - post arm/FA, lat elbow, tumb, dorsal hand
  4. median
    motor - flexors, pronators of FA; flex wrist
    sensory - palm, index, middle fingers
  5. ulnar
    motor - flexor carpi ulnaris; abduct (open) fingers
    sensory - ring finger, pinky
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you assess block?

A

nerve stimulator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are other things to consider administering prior/during regional block?

A

-sedation: prop/midaz/fent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 4 approaches to block the brachial plexus?

A
  1. interscalene
  2. supraclavicular
  3. infraclavicular
  4. axillary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of surgery is the interscalene approach used for? What does it block?

A
  • procedures proximal to elbow: shoulder (except posterior), clavicle or upper arm surgery
  • blocks upper branches of BP and lower CP; SPARES ULNAR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the landmarks for the interscalene approach?

A
  • C6
  • posterior clavicular head of sternocleidomastoid
  • palpate groove between ant and middle scalene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are absolute and relative contraindications of interscalene block?

A
  • ABSOLUTE: contralateral RLN palsy, phrenic n palsy

- Relative: preexisting n injury, BP pathology, significantly impaired pulm function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

At what level do you start the nerve stimulator?

What level to you decrease it to during assessment?

A
  • 1.0 mAmp

- 0.5 mAmp (if still twitching, then accurate site for injection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What twitch would the interscalene approach elicit before block placed?

A

Twitch of bicep or distal hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When ready to place block, how do you inject? How much?

A

Aspirate (no heme, air, CSF), inject 20-30 ml of LA while aspirating after every 5 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you evaluate the interscalene block?

A
  • push (extension - radial n)
  • pull (flexion - musculocuatenous n)
  • close index finger (median n)
  • open little finger (ulnar n)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are complications of interscalene block?

A
  • intravascular injection
  • SAB or epidural
  • Pneumo
  • RLN block
  • Horner’s syndrom (ptosis, myosis, lack of sweating)
  • Phrenic n block (weakness NOT impairment of diaphragm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are indications for cervical plexus block?

A
  • unilateral neck surgery

- can be combined with deep cervical plexus block for carotid endarterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the landmarks for cervical plexus block?

A

-posterior border of SCM at midpoint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How much LA do you inject for cervical plexus block?

A

5 ml

19
Q

What is a supraclavicular block used for?

A

-upper extremity surgery

20
Q

What does the supraclavicular approach block?

A
  • all portions of upper extremity (hand, FA, upper arm)
  • blocks TRUNKS/divisions of brachial plexus
  • does not always include axillary
21
Q

What are contradictions for supraclavicular block?

A
  • contralateral phrenic paralysis
  • RLN paralysis
  • contralateral pneumo
22
Q

What are the landmarks of the supraclavicular block?

A
  • lateral border of clavicular head of SCM as it inserts into clavicle
  • interscalene groove
23
Q

What is the twitch response for a supraclavicular block?

A

-hand or arm
-more distal the response, more reliable the block
(motor response usually + at 2-3 cm; if still present at 0.5 mAmp or less = INJECT)

24
Q

What are supraclavicular complications?

A
  • pneumothorax (HIGHEST RISK)
  • horner’s syndrom
  • phrenic nerve block
  • RLN paralysis
  • neuropathy (nerve pinned against clavicle)
25
Q

What is an infraclavicular approach used for? What does it block?

A
  • surgery on elbow, FA, hand (elbow and below)
  • good for continuous catheter placement
  • blocks cords of BP
26
Q

What are the landmarks for infraclavicular block?

A

-insert needle midpoint between medial clavicular head and coracoid process

27
Q

What twitch would you see for infraclavicular approach?

A
  • pectoralis twitch = too shallow
  • median, radial, ulnar twitch (5-8 cm depth)
  • point needle LATERALLY to avoid neuraxial/pulm complications
28
Q

What is an axillary block used for? How safe is it?

A
  • surgery below elbow

- safest and easiest approach

29
Q

What does the axillary approach block?

A

-branches of BP, musculocutaneous may be missed

30
Q

What is pt positioning for axillary block?

A
  • pt supine
  • arm extended 100 degrees
  • FA flexed at 90 degree angle
31
Q

What are absolute contraindications for axillary block? Relative contraindications?

A
  • lymphgangitis

- preexisting nerve injury, BP pathology

32
Q

What are the landmarks and anatomical location of the nerves in the axillary approach?

A
  • palpate axillary artery
  • median n = sup/ant to axillary artery
  • ulnar n = inf to axillary artery
  • radial n = post to axillary artery
33
Q

What is the techniques for the axillary approach?

A
  1. nerve stimulator
  2. transarterial
  3. paresthesia
34
Q

Describe the nerve stimulator approach for axillary block.

What twitch would be elicited?

A
  • insert needle sup.inf to palpation of axillary a
  • 1.0 mAmp
  • distal hand twitch
35
Q

What is the diff between one injection versus multiple via nerve stimulator?

A
  • electrolocation of 1 nerve = same as 2 or 3 nerves

- one nerve - faster, easier

36
Q

Describe the transarterial technique for axillary block.

A
  • palpate axillary artery and aspirate bright red blood

- advance further until no blood, inject LA

37
Q

Describe the paresthesia technique for axillary block. What are things to consider with this technique?

A
  • elicit paresthesia in terminal n

- timely, uncomfortable

38
Q

What do you evaluate for an axillary block?

A
  • push - radial n
  • pull - musculocutaneous (often spared; separate injection)
  • close - median n
  • open - ulnar
39
Q

What are complications for an axillary block?

A
  • hematoma
  • IV injection
  • infection
40
Q

Describe landmarks for touch up nerve blocks:

  1. radial
  2. median
  3. ulnar
  4. musculocutaneous
A
  1. brachioradialis m and biceps tendon
  2. medial to brachial artery
  3. flex FA, proximal to ulna groove
  4. deep in coracobrachialis
41
Q

When is a bier block used?

A

ideal for FA and hand cases that are 60 min (and up to 120 min)

42
Q

Describe a bier block technique.

A
  • cannulate distal vein
  • exsanguinate arm with 2 proximal touniquets
  • inject LA (onset = within 5 min)
43
Q

What are disadvantages to bier block?

A
  • LA

- be prepared to treat with O2/ambu, barbs/benzos/intubation

44
Q

What are advantages for ultrasound guidance?

A
  • direct visualization
  • reduced complications and S/E
  • useful in complex anatomy
45
Q

What are disadvantages for ultrasound guidance?

A
  • operate knowledge and skill
  • familiarity with visualized anatomy
  • cost
  • clinical results = nerve stimulator technique

*Anesthesia Concepts 1 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions