Valley Module 9a Regional Flashcards
how many vertebrae does the spinal column contain?
33 7 cervical 12 thoracic 5 lumbar 5 sacral 4 fused coccygeal
how many cervical, thoraric, lumbar and sacral vertbare are there ?
7 cervical 12 thoracic 5 lumbar 5 sacral 4 fused coccygeal
state the high and low points of the spinal column in the supine position
High - L3, C3
Low - S2, T6
discuss the anatomic relationship of the spinal cord and the supraspinous, interspinous and ligamentum flavum ligaments
SPCADEL,
spinal cord, pia , CSF, arachnoid, Epidural, Ligamentum flavum, interspinous and then supraspinous
discuss and describe the epidural space
SPCADEL
between dura and ligamentum flavum and is a potential space
describe the anatomic relationship & functions of the meninges - dura, pia, arachnoid
SPCADEL
dura - hard mother, outermost, tough
arachnoid - spider mother, delicate nonvascular
pia - delicate highly vascular
subarachonid space is where the csf is located
how do vasoconstrictors work for spinal?
prolong the duration of action by decreasing absorption , prolong both sensory and motor block
identify the factors that affect agent distributionn during spinal anesthesia
age (minimal) pt height ( minimal) needle angle volume of CSF (pregnant/obese) site of injection Type of local - baricity, density, dose, position after spinal
what factors determine duration of spinal anesthesia
local anesthetic choice (density) & total dose administered
describe how/why bradycardia may occur during spinal anesthesia
stems from a blockade of thoarcic sympathetic fibers at T1-T4, also relfexive slowing from vasoldilation reducing venous return to RA, gives heart time to refill from low pressure stretch receptors (Bezold Jarisch)
how would you treat hypotension during spinal aneshtesia
fluids (if not normovelmic) & ephedrine (if normovolemic)
best way is by physiologic not pharmacologic
discuss respiratory changes during spinal anesthesia; how/why does apnea occur
if high spinal reaches T2-T4 can get loss of perception of intercostal and abdominal wall movement,
from paralysis of abdominal muscles,
APNEA = from hypoperfusion of the respiratory centers in the medulla secondary to severe hypotension
compare and contrast how cutting and pencil point needles should be used
with emphasis on penetrating the dura
dura fibers runs head to toe and pencil point should face up towards head always, cutting needles need to be perpendicular to dural fibers so they need to always point toward lateral sides so they dont tear but rather seperate fibers
review and memorize the dermatome levels
C4 clavicle C7 cervical spinous process can feel T4 Nipple T6 Xiphoid T7 scapula T8 lower rib cage T10 belly button L2 knee L4 Iliac crest S2 post. Superior iliac spine (has 2 S in name) S2-s5 perineum
list the indications for spinal block
no absolute indications but can help if full stomach, upper airway distortions, TURP, Decreased postop pain, continuous infusion, if simpler and faster
