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Regional 540 - PM > Week 3- Brachial Plexus And Wrist > Flashcards

Week 3- Brachial Plexus And Wrist Flashcards

0
Q

The phrenic nerve is a major component of __ innervation

A

Diaphragm

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1
Q

What spinal nerves make up the cervical plexus?

A

C1-C5

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3
Q

What spinal nerves make up the phrenic nerve? Which one is the major contributor?

A

C3-C5

Major - C4 - like the plastic explosive “C4” which could blow up your “phriend” the phrenic nerve

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4
Q

What spinal nerves make up the brachial plexus?

A

C5-T1 (includes “C8”)

5 cats and 1 turkey made a “break” for the opening in the barn door

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4
Q

What block would you do for a carotid endarterectomy?

A

Cervical plexus

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5
Q

How would you locate the cervical plexus using landmarks?

What is the technique for the block?

A

Feel the mastoid process behind your ear, then using your thumb width march down the posterior edge of the sternocleidomastoid in stepwise fashion until reaching anterior tubercle of C6 (Chassaignac’s Tubercle)
“Thumb drive”
First aspirate, the inject 4ml per level SUPERFICIALLY

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6
Q

If your patient developed hiccups, what nerve was inadvertently blocked?

A

Phrenic

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7
Q

What might be some complications of a cervical plexus glock?

A

Hiccups (phrenic nerve)
Horner’s syndrome
Hoarseness (recurrent laryngeal)
Intrathecal (subarachnoid) or Epidural injection

Sticking a needle a couple times in the side of someone’s neck is no laughing matter- H-H-HIE !!!

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8
Q

What are the symptoms of Horner’s Syndrome?

A 
Ptosis- droopy
Miosis- constricted
Anhydrosis- no sweat
Enophthalmosis- sunken eye
Scleral hyperemia- red eye
Facial flushing- red face
Nasal congestion- stuffed up
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9
Q

If your patient developed hoarseness, what nerve was inadvertently blocked?
What is the mechanism?

A

Recurrent laryngeal

One of their vocal cords is relaxed

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10
Q

What is Horner’s syndrome indicative of?

A

Stellate ganglion block, medial to (deeper) brachial and cervical plexus

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11
Q

Why would morbidly obese patients no be ideal candidates for superficial cervical plexus blocks?

A

Inability to determine depth of infiltration or anatomical landmarks

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13
Q

When you perform an interscalene, you are blocking distal _ and proximal _

A

Roots
Trunks
“real trojans”

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14
Q

Real Trojans Drink Cold Beer

A 
Roots
Trunks
Divisions
Cords
Branches
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15
Q

Dermatomes

tips of fingers and most of palm

A

Median nerve, nice to “meet” you, when you shake hands your “meetian” nerves touch

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16
Q

Dermatomes

hairy part of hand and forearm including halfway up tricep

A

Radial nerve, my arm hairs “radiate” from hand to my elbow and start to taper off 1/2way up my tricep.
basically completely opposite of radial art line insertion site

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17
Q

Dermatomes

pinky fingers both top and bottom

A

Ulnar nerve, when you give a thumbs down to a bad performance you would say that it was “uhhhh”, or have you ever noticed when you take a drink your pinky sticks out and makes a “U” with your face?

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18
Q

Dermatomes

the “arm wrestler” muscle

A

Musculocutaneous, imagine yourself arm wrestling, you would look right at that “muscle” to will it to pull harder.

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19
Q

Dermatomes

on the ulnar side of the inner forearm, right next to the musculocutaneous

A

Medial antebrachial cutaneous nerve, it is “medial” to the musculocutaneous and “ante” means before, so “ante” or before the brachial, think of the brachial artery is where you feel infant’s pulse during PALS. Or if you were a poker player maybe you would look at that part of your arm before you place a “middle ante” bet on the cards in your hand.

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20
Q

Dermatomes

above the scapula

A

Suprascapular nerve, exactly what you would think “supra” or above the scapula on your back

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21
Q

Dermatomes

opposite your armpit

A

Axillary nerve, which is completely opposite of where I would have thought the axillary nerve was, it is opposite the armpit

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22
Q

Dermatomes

armpit

A
  • high anterior is Intercosto-brachial, it’s “inter” or between your costals (ribs) and your brachial artery
  • low armpit is Medial cutaneous, which is where the “meat” smell comes from
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23
Q

Where is Chassaignac’s Tubercle?

A

C6

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24
Q

What is another name for “roots” that also starts with an “R”?

A

Rami

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25
Q

How many roots make up the ventral rami of the brachial plexus?

A

5, (c5, c6, c7, c8, t1)

5 cats and 1 turkey made a “break” for the barn door

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26
Q

How many trunks in the brachial plexus?

A

Three, (superior, middle, inferior)
Three trunky trojans had a beer drinking contest and one emerged superior, another was in the middle, and of course the Mormon was inferior at drinking beer.

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27
Q

How many anterior and how many posterior DIVISIONs in the brachial plexus?

A

3 and 3. It’s like the city league “division” basketball game that was 3 on 3.

28
Q

How many CORDs in the brachial plexus?

A

3, medial, posterior, lateral. I have three “cords” going to my TV, the one in the middle is the power, the one in back is the antenna, and the one on the side is for the DVD.

29
Q

How many terminal BRANCHes in the brachial plexus and what are their names?

A

5, MARMU
musculocutaneous, axillary, radial, median, ulnar
branches reminds me of maple trees, Maples Are Really Multicolored Usually (in the fall when the branches turn from green to red and orange)

30
Q

Easy way to remember how many of each of the Roots, Trunks, Divisions, Cords, Branches

A

5, 3, 3-3, 3, 5

31
Q

If you wanted to block the CORDs only, which block would would you do?

A

Infraclavicular, the cords on my TV go to the “infra”red remote control

32
Q

Supraclavicular block is a combination of __ and __

A

trunks

divisions

33
Q

Axillary blocks is __ only

A

branches

34
Q

The blocks from neck to shoulder

A

cervical plexus, interscalene, supraclavicular, infraclavicular, axillary
CISIA

35
Q

what spinal nerves (besides c5-6) does musculocutaneous communicate with?

A

c7, “musculo” has seven letters

36
Q

what spinal nerves (besides c5-6) does axillary communicate with?

A

none, only c5-6 and the others got “axed”

37
Q

what spinal nerves (besides c5-6) do radial AND median communicate with?

A

c7,c8,t1. ALL of the nerves of the brachial plexus. They ALL “radiate” from the neck to the “middle” of the arm

38
Q

the ulnar nerve is uuhhhhh so lame! it DOESN’T communicate with c5,6 like all the others! what spinal nerves does it communicate with?

A

c7,c8,t1, ALL of them BUT 5 and 6 because uuuhhhh it is so lame!

39
Q

there are five acceptable muscles which, when stimulated, demonstrate proper placement for an interscalene block, what are they?

A

pec’s, bicep, tricep, deltoid, forearm

arm, shoulder, and chest

40
Q

__ sternocleidomastoid is the proper placement for the interscalene block

A

posterior. feel parasthesias in your shoulder when you palpate it.

41
Q

on your nerve stimulator, start at _ milliamp

A

1

42
Q

0.2 - __ milliamps is acceptable to inject

A

0.5

43
Q

interscalene block is great for __ surgery

A

shoulder

44
Q

is interscalene appropriate for hand surgery?

A

NO, the ulnar nerve is frequently not blocked

45
Q

how many mils of LA for interscalene block?

A

30ml

46
Q

What does an unintentional phrenic nerve block look like?

A

unilateral hemidiaphragmatic paralysis, on xray one side of diaphragm will be elevated. “that thing got a hemi?”

47
Q

the two longest acting LA’s are _ and _, they last 4-12 hours

A

bupivicaine

ropivicaine

48
Q

the supraclavicular is a VERY ADVANCED BLOCK, it has a HIGH probability of __, use ultrasound because it is TIGHT TIGHT TIGHT (three tight’s = three __)

A

pneumothorax

three trunks

49
Q

the “spinal” of the arm, nothing is spared, not even the ulnar

A

supraclavicular

50
Q

why would you NEVER perform a bilateral brachial plexus block?

A

because you’d end up blocking bilateral phrenic nerves and have bilateral diaphragm paralysis

51
Q

the landmarks and nerves for the infraClaviCular bloCk all have a lot of C’s

A

coracoid, clavicle, cords

52
Q

the axillary block is good for anything mid-___ all the way down the arm and works on the __ section of nerves

A

humerus

branches

53
Q

what nerves will you block with an axillary block?

A

Ulnar, Median, and Radial

axillary block keeps you from lifting your RUM

54
Q

stimulation of musculocutaneous gives your flexion of the __ and would indicate that you are NOT in position for the axillary block

A

bicep

55
Q

what block might you do for an AV fistula on the forearm?

A

axillary

“Sick, sick people, ASA 4’s everyone of ‘em”

56
Q

how much LA would you inject for a radial or ulnar nerve block?

A

4 mils

57
Q

the motor movement of the radial nerve is __

A

“radiate” and “rotate”, extension of elbow, wrist, and fingers and supination of arm

58
Q

the motor movement of the median nerve is __

A

hand face down, wrist flexed, fingers coming together like a duck beak

59
Q

the motor movement of the ulnar nerve is __

A

flexion of wrist, adduction of all fingers, flexion and opposition of medial two fingers toward thumb

60
Q

the motor movement of the musculocutaneous nerve is __

A

bicep, flexion at elbow

61
Q

which nerve is not routinely blocked with the interscalene block?

A

ulnar

62
Q

which block is appropriate for shoulder surgery?

A

interscalene and supraclavicular

63
Q

what volume for an interscalene block

A

30 mils

64
Q

this nerve extends elbow, wrist, and fingers

A

radial

65
Q

this nerve flexes wrist

A

ulnar or median

66
Q

if you obtain a twitch at 0.15 milliamps, is it ok to inject?

A

NO, because it’s not between 0.2 and 0.5 milliamps

Regional 540 - PM (8 decks)

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