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SUM'20 - Regional > US > Flashcards

US Flashcards

1
Q

Resolution is defined as

A

ability to clearly distinguish 2 structures lying beside one another

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2
Q

Focus is defined as

A

focus should be placed at level of object being assessed

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3
Q

Gain is defined as

A

intense or decrease the signal intensity (brightness)

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4
Q

what frequency does ultrasound use? MHz when US travels into the body and has contact with various tissues- what can it do?

A

Uses high frequency (1-20 MHz) sound waves emitted from multiple piezoelectric crystals inside a transducer rapidly vibrate in response to an alternating electric current… US then travels into the body where, on contact with various tissues, can be reflected, refracted, and scattered

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5
Q

High frequency

A

transducers provide a high-resolution picture with a relatively clear image but offer poor tissue penetration, thus used for more superficial nerves

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6
Q

Lower frequency

A

transducers provide an image of poorer quality but have better tissue penetration, thus used for deeper structures

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7
Q

Modes:

A

amplitude (A) mode brightness (B) mode (most commonly used for ultrasound guided regional anesthesia) motion (M) mode

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8
Q

for superficial structures use what frequency

A

high frequency greater than or equal to 7MHz

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9
Q

for peripheral nerve blocks frequencies range from

A

3-15MHz

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10
Q

transducers with a range of 10-15MHZ- what is their negative attribute

A

you become limited to what is 2-3cm below the skin- penetration is limited.

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11
Q

Transducer movement ART

A

A= alignment (side longitudinally) R= rotation (rotate clockwise/counter clockwise) T=tilting (tilting or angling the transducer

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12
Q

<2.0cm field depth=which block

A

wrist, ankle block

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13
Q

2-3cm field depth= which blck

A

interscalene, axillary, brachial plexus block

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14
Q

3-4cm field depth

A

femoral, supraclavicular, transverses abdomens plane block

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15
Q

4-7cm field depth

A

infraclavicular, popliteal, subgluteal, sciatic nerve blocks

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16
Q

7-10cm block

A

pudendal, gluteal sciatic nerve, lumbar plexus block

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17
Q

>10cm

A

anterior approach to sciatic nerve

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18
Q

use of a peripheral nerve stimulator

A

this concept will be on the exam.

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19
Q

mode most commonly used for ultrasound guided regional anesthesia

A

brightness (B) mode

20
Q

field depth for placing interscalene, brachial plexus block?

A

2-3 cm

21
Q

field depth for placing femoral block?

A

3-4 cm

22
Q

field depth for placing gluteal sciatic nerve block?

A

7-10 cm

23
Q

field depth for placing popliteal block?

A

4-7 cm

24
Q

screen brightness can be adjusted manually by TWO function buttons:

A

Gain Time-gain compensation (TGC)

25
Q

Excessive or inadequate gain can cause both a blurring of

A

tissue boundaries loss of information

26
Q

optimal gain for scanning peripheral nerves is typically the gain at which the best contrast is obtained b/w the

A

muscles and the adjacent connective tissue

27
Q

PNB set up: (keep in mind)

A

-Ultrasound machine -Transducer covers -Nerve block kit -Peripheral nerve stimulator -Sterile work station -Local anesthetic drawn up and labeled -Sedation medications drawn up and labeled -Connect the ultrasound machine to the power outlet -Comfortable patient position -The ultrasound machine should be set up on the opposite side of the patient -Tray should be positioned close -Ambiance-set room settings: Adjust the lights in the room in order to view the ultrasound machine

28
Q

to ease visualization, what needle selection should be made?

A

large bore needles (17G) -preferred for deep blocks

29
Q

for more superficial blocks, what size needles would be ok?

A

smaller bore needles (22G) -also more comfortable for awake pts

30
Q

An _____ needle concentrates electrical current at the needle tip while a wire attached to the needle hub connects to a nerve stimulator

A

insulated

31
Q

PNS are used to:

A

accurately identifiy specific nerves/improve adequacy of block

32
Q

PNS grounding electrode is attached to

A

the pt “to complete the circuit”

33
Q

when an insulated needle is placed in proximity to a motor nerve…. what happens?

A

muscle ctx are induced

34
Q

Needle placed inline with and parallel to

A

the transducer (ultrasound beam). Both the needle shaft and tip are visualized

35
Q

PNB technique - Set up: fyi/review

A

-2-person technique (find an assistant) -Standard monitors (B/P, ECG, Pulse ox) -Have O2, suction, resuscitative -medications & equipment readily available -Locate crash cart and intralipid -Before starting the procedure, check for the proper functioning of the nerve stimulator and the connecting cables -Pre-medicate (but don’t “over sedate”) —>Short acting benzodiazepine and opioid titrated for comfort –>Patient should always respond to verbal cues -Position patient properly (favorable for clinician and comfortable for patient) -negative pole should be connected to the stimulating electrode (needle) and the positive pole to the patient’s skin -Time-out -Disinfect the skin/create sterile field -Connect the nerve stimulation needle to the nerve stimulator (which should be turned on once in the subcutaneous tissue), and adjust PNS to deliver 2 mA after introduced into subcutaneous tissue (turning it on sooner will cause the patient pain) -Apply sufficient amount of gel to transducer -Position transducer (always stay within sterile field)/ place transducer on skin and adjust settings -Introduce needle/begin procedure

36
Q

-negative pole should be connected to the ______ and the positive pole to the _____.

A

-stimulating electrode (needle) -patient’s skin —-Negative-needle —-Positive-skin

37
Q

When would you turn on the PNS?

A

once in the Subcutaneous tissue -adjust to deliver 2mA AFTER introduced into subq tissue (any sooner, cause pain to pt)

38
Q

PNS technique continued - from needle penetration on… (fyi/review)

A

-As needle approaches sheath, continuously reduce the mA so that the muscle response to the stimulation is maintained -Once the sought-after muscle response is obtained, the current intensity amplitude is gradually reduced and the needle is advanced further SLOWLY -Advancement of the needle and current reduction are continued until the desired motor response is achieved with a current of 0.2-0.5 mA stimulus duration ***** Optimal LA injection is when muscle contraction/response is maintained at a current between 0.2-0.5 mA ***** If muscle contraction is elicited < 0.2 mA, there could be increased risk of intraneural injection (neural damage)

39
Q

***-Advancement of the needle and current reduction are continued until the desired motor response is achieved with a current of

A

0.2-0.5 mA stimulus duration

40
Q

***** Optimal LA injection is when muscle contraction/response is maintained at a current

A

between 0.2-0.5 mA

41
Q

***** If muscle contraction is elicited < 0.2 mA, there could be increased risk of

A

intraneural injection (neural damage) ** we want LA AROUND the nerve, not IN the sheath.

42
Q

Once a proper motor response is obtained with a current of 0.2-0.5 mA (most nerve blocks), the needle is

A

positioned correctly for an injection of local anesthetic

43
Q

***When the needle is in confirmed position, what do you do next?

A
  • ASPIRATE! - A small test dose of local anesthetic is injected, which abolishes the muscle twitch **STAY STILL!! now blocked and you won’t get muscle twitch again**
44
Q

If the motor twitch is lost during needle advancement, the stimulus intensity first should be

A

increased to regain the muscle twitch rather than move the needle blindly

45
Q

insert PNS image

A

Black - to needle Red - to pt for grounding

46
Q

charting considerations for block:

A

-twitch elicited -sustained up to -where you placed -how much LA you gave -insertion? …. etc.

SUM'20 - Regional (17 decks)

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