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Regional 540 - PM > week 4- femoral and ankle > Flashcards

week 4- femoral and ankle Flashcards

1
Q

If you get a negative aspirate, does that mean you are not within a blood vessel? AKA ball valve phenomenon

A

No, you could be inside the lumen and sucking the far vessel wall up against the end of the needle, creating negative aspirate but still being within the vessel.

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2
Q

If your patient seizes due to LAST, should you continue with surgery?

A

NO, monitor patient for 23 hours and create a record.

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3
Q

Femoral nerve block works on __ thigh, __, and the medial aspect __.

A

anterior thigh
patella
medial aspect below the knee

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4
Q

Can your patient walk after getting a femoral nerve block?

A

NO, non-weight bearing for the length of LA duration, due to quad weakness.

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5
Q

Reasons to get a femoral nerve block

A

repair quad tendon, quad muscle biopsy, saphenous vein stripping, femur and knee surgery, femur fractures, total knee replacement arthroplasty.

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6
Q

ABSOLUTE contraindications for femoral nerve block

A

practitioner inexperience, patient refusal, infection at the site

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7
Q

What is the double crush phenomenon?

A

when someone has pre-existing peripheral neuropathy and you dump local anesthetic on them that limits blood flow to that nerve

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8
Q

RELATIVE contraindications for femoral nerve block

A

previous femoral vascular graft, large lymph nodes or tumor, pre-existing femoral neuropathy (double crush)

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9
Q

the femoral nerve is the __ of the lumbar plexus

A

largest

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10
Q

what spinal nerves make up the lumbar plexus?

A

T12-L5. Our “Tee” time is at 12, so we’ll be done by 5 at the “Latest”

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11
Q

what spinal nerves does the femoraL nerve originate from?

A

L 2,3,4

there are 3 vowels in femoral

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12
Q

As the femoral nerve passes into the thigh it divides into the __ and __ branches

A

anterior and posterior

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13
Q

ABOVE the fascia __ (and below the fascia lata), the anterior branch innervates the __ and __ muscles

A

fascia iliaca

sartorius and pectineus muscles

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14
Q

BELOW the fascia __, the posterior branch innervates the __ muscle and knee joint and gives off the __ nerve

A

fascia iliaca
quadriceps muscle
saphenous nerve

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15
Q

the __ nerve supplies the skin of the medial aspect of the leg below the knee and is __ only

A

saphenous nerve

sensory only

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16
Q

you must pierce BOTH the fascia __ and the fascia __ to provide a femoral nerve block

A

fascia lata

fascia iliaca

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17
Q

if you accept the sartorius and inject, you just __ your local anesthetic

A

wasted

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18
Q

if you pierce the fascia iliaca and accept twitches from quads and patella, you just hit

A

pay dirt

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19
Q

nerve artery vein from lateral to medial

A

NAV

20
Q

the only two dermatomes to memorize for the femoral block are the femoral and saphenous

A

can you point them out on your own leg?

21
Q

point of injection for a femoral block is down one cm from __ crease and lateral one cm from __ artery

A

down one cm from inguinal crease

lateral one cm from femoral artery

22
Q

why inject cephalad with a femoral block?

A

better opportunity to cover all of the posterior component.

23
Q

when doing a femoral nerve block, if you don’t get any twitches, what is the problem and solution?

A

probably too far medial or lateral, relocate femoral artery and reinsert using systematic angulation

24
Q

when doing a femoral nerve block, if you hit bone, what is the problem and solution?

A

too deep, withdraw to skin level and reinsert in different direction

25
Q

when doing a femoral nerve block, if you get a local twitch, what is the problem and solution?

A

probably directly stimulating illiopsoas or pectineus muscle and too deep, withdraw to skin level and reinsert in different direction

26
Q

when doing a femoral nerve block, if you get sartorius muscle twitches, what is the problem and solution?

A

too anterior and medial, redirect laterally and advance 1-3 mm deeper

27
Q

when doing a femoral nerve block, if you get positive aspirate, what is the problem and solution?

A

femoral artery puncture, needle too medial, withdraw needle (if hematoma hold pressure 2-3 minutes), then reinsert 1 cm more lateral

28
Q

when doing a femoral nerve block, if you get patella or quad twitch, what is the problem and solution?

A

NO PROBLEM, accept and inject, pay dirt

29
Q

What are some indicators of possible intraneural injection?

A

severe pain, high pressure to inject

30
Q

“B” bevel needes have a shorter bevel, thus a greater angle of bevel.

A

just fyi

31
Q

what to do with a sartorius twitch

A

direct more lateral and deeper

32
Q

in order to be successful at an ankle block, you must block __ nerves, all of which are __

A

five nerves

sensory, NO motor

33
Q

What are some indications for ankle block?

A

any surgery on the foot

34
Q

what are some contraindications for ankle block?

A

patient refusal, infection, edema, burns, soft tissue trauma, distorted anatomy, vascular compromise, severe coagulopathy

35
Q

what are the five nerves involved in ankle block?

A 
saphenous
post. tibial
sural
superficial peroneal
deep peroneal
36
Q

where does the saphenous nerve come from and what spinal nerves specifically?

A

femoral nerve

L3-4

37
Q

where do the superficial and deep peroneal nerves originate from?

A

common peroneal (AKA common fibular)

38
Q

where do the posterior tibial and sural nerves originate?

A

tibial nerve

39
Q

where do the tibial and common peroneal nerve originate?

A

sciatic nerve

40
Q

the tibial nerve is __ and the common peroneal is __

A

tibial - medial (makes sense because the tibia or shin bone is more medial than the fibula)
peroneal - lateral

41
Q

To inject the posterior tibial, go between the __ malleolus and the Achilles tendon.

A

Medial malleolus

42
Q

To inject the sural, go between the __ malleolus and the Achilles tendon.

A

Lateral malleolus

43
Q

To inject the deep __, go right between the two tendons (extensor hallucis longus and extensor digitorum longus)

A

Deep peroneal

44
Q

To inject the superficial peroneal, go right between the two tendons (extensor hallucis longus and extensor digitorum longus) then aim __

A

Aim lateral

45
Q

To inject the saphenous, go right between the two tendons (extensor hallucis longus and extensor digitorum longus) then aim __

A

Medial

46
Q

Three complications of ankle blocks are paresthesias, LAST, and __ reaction

A

Vasovagal reaction

47
Q

Is foot drop a potential complication of femoral block?

A

NO, sensory only.

Regional 540 - PM (8 decks)

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