Week 12 Upper Extremities Flashcards
What is a superficial cervical block for?
Surgery of the neck, shoulder, thyroid, CEA
What are the landmarks for superficial cervical block?
- Mastoid Process
- Transverse procress of C-6
- Posterior border of SCM
How do you find the transverse process of C-6?
-Palpable behind clavicular head of SCM just below level of cricoid
Describe a field block technique for a superficial cervical block?
- 10 to 15 mL
- Superior and inferior redirections along posterior border of SCM
- DO NOT go any deeper than 1 cm.
What are complication of a superficial cervical block?
- Infection
- Hematoma
- LA Toxicity
- Nerve Injury
- Phrenic nerve block
- Inadvertant subarachnoid or epidural
- TIA
- Recurrent Laryngeal nerve block
What are the landmarks for interscalene block?
- Sternal head of SCM
- Clavicular head of SCM
- Upper border of cricoid cartilage
- Clavical
When doing a interscalene block with a nerve stimulator you see shoulder movement. What nerve is this?
-Suprascapular nerve
What are complications to a interscalene block?
- NEUROPATHY
- MECHANICAL -PLEXUS INJURY
- INFECTION
- PNEUMOTHORAX
- LA TOXICITY
- Spinal or epidural
- intervertebral injection
- Phrenic nerve block
- Hormer’s syndrome
What are indication for a supraclavicular block?
- Any upper extremity NOT involving shoulder
- Excellent for elbow and hand
T/F: Bilateral supraclavicular block can be done.
FALSE
What are the land marks for a supraclavicular block?
- Lateral insertion fo SCM to clavicle
- Clavicle
- Patients midline
What is the position for a supraclavicular block?
-Semi sitting blockwith head to opposite side
-Lower shoulder with elbow flexed and relaxed
-Palm supinated
monitor for stimulation
What is the best technique for a supraclavicular block?
-ULTRASOUND
What are the complications of a supraclavicular block?
-Phrenic nerve block
-Horner’s Syndrome
-Pneumo
-LA toxicity
-Nerve Damage
-
What would be a contraindication for a infraclavicular block?
-Coagulation
What are the landmarks for infraclavicular block?
- Clavicle
- Jugular Notch
- Acromioclavicular joint (AC)
- Coracoid process
What are some complication of an infraclavicular block?
- Hematoma
- Nerve Damage
- LA Toxicity
- Low risk of Pneumo if not directed medially
What are the indication for axillary block?
-Surgery of forearm, wrist, or hand
What may not be cover with a axillary block?
-musculocutaneous nerve
What three sheaths run with axillary artery?
- Radial
- Medial
- Ulnar
What are the landmarks of a axillary block?
Pulse of axillary artery
- Coracobrachialis muscle
- Pec. Major
- Biceps
- Triceps
What are the indication for a wrist block?
- Carpel Tunnel
- Hand
- Finger
What tendons reside next to the median nerve?
- Plamaris longus
- Fexor carpi radial
Where does the radial nerve reside?
-Brachioradialis muscle
Where does the ulnar nerve reside?
- ulnar artery
- tendon of lexor carpi ulnaris
Where do the nerves run on the digit?
-Ventrolateral aspect of the finger
What drug would never be used for a digit block?
-Epinephrine
