1 Flashcards
(289 cards)
1
Q
male DLT sizing
A
39 F (if < 170 cm)
41 F (> 170 cm)
2
Q
female DLT sizing
A
35 F if < 160 cm
37 f if > 160 cm
3
Q
male and female DLT depth
A
male- 29 cm
female 27 cm
4
Q
peds dlt sizing
A
8-9 F = 26
10-12 = 28
12-14 = 32
5
Q
where do you clamp dlt
A
distal to y piece and open air vent
6
Q
what is applied to non dependent lung and what is applied to dependent with DLT
A
cpap 40 cmh2o for 8 seconds non depedent (up) lung
peep 5-10 cmh2o to dependent lung
7
Q
what can bronchial blockers NOT do
A
-ventilate isolated lung
-suction secretions, blood or pus
-isolate contralateral lung infections
8
Q
what can bronchial blockers do?
A
-lung isolate peds < 8-10 yo
-insufflate o2 to isolated lung
-isolate for nasal intubations
-suction air from isolated lung
9
Q
bronchial blockers indications
A
-peds < 8 yo
-nasal intubation w isolation
-tracheostomy
10
Q
how do you place a bronchial blocker
A
intubate with single ETT- insert BB through ETT- place in lung to isolate
11
Q
complications/ risks of mediastinoscopy
A
- hemorrhage
- pneumothorax
12
Q
what side should pulse ox/ a line be on with mediastinoscopy
A
r arm- looking for r inomminate artery compression
13
Q
what should be on L side with mediastinoscopy
A
nibp
iv should be in lower extremity
prbc in room
14
Q
contraindications to mediastinoscopy
A
absolute: previous MEDS
reltive: tracheal deviation, thoracic AA, svc obstruction
15
Q
tracheal resection: upper vs lower lesion
A
-upper tracheal lesion- advance standard ETT distally before trachea is open may do distal 2nd ett after trachea is open
-if lower lesion: place ETT above lesion. after trachea opened 2nd ett placed in L main bronchus to ventilate while surgeon sutures tracheal anastamosis. 2nd L mainstem ett is removed and origional ett gets advanced past anastamosis into L bronchus
16
Q
ards lung strategies
A
-pcv
-vt 4-6 ml/kg IBW
-peep fio2 <50
-plateau pressure < 30
-RR to allow permissive hypercapnia
-i:e 1:1 for restrictive or 1:3 for obstructive
-pao2 55-80 and spo2 88-95%
17
Q
ards berlind definition
A
pao2 / fio2 ratio
mild= 200-300
moderate= 100-200
severe < 100
18
Q
who should not get a needle cric
A
peds <6 yo
19
Q
c/i to tracheostomy
A
none
20
Q
airway exchange catheter. what can you do through it?
A
etco2, jet vent, o2 insufflate through AEC
21
Q
what cant you do through airway exchange catheter
A
suction
22
Q
airway exchange catheter is usually __ at lip
A
25
23
Q
what is autopeep and who is at risk
A
obstructive air trapping
elderly, copd, emphysema, asthma
24
Q
what can cause angioedema and how do you tx it
A
ace-i and c1 esterase deficiency
give ffp and c1 inhibitor concentrate, ecallatide, icatibant
25
#1 cause of nerve injury in LMAs
cuff overinflation (lingual, hypoglossal and RLN at risk)
26
when is an LMA okay with laproscopic
< 15 minutes, <15 degrees trend, abd pressure < 15 mmhg
27
max pos pressure and max lma cuff volume
max pressure: < 20
max LMA cuff volume: <60
28
proseal lma
has gasric drain
reusable
built in bite block
29
lma supreme
gastric drain
disposable version of proseal
30
fasttrach lma
can intubate through it
cannot go into mri
31
flexible lma
wire reinforced
head and neck surgery
32
igel lma
no cuff- for spont ventilation
gastric decompression
33
combitube
gastric drain/ suction port
double lumen/ double cuffed
34
king tube
gastric drain- single lumen and cuff
35
indications for retrograde intubation
-unstable c spine
-upper airway bleeding
-mandibular fracture
36
c/i to retrograde intubation
-cannot access CTM
-goiter
-neck deformaties (tracheal airway tumors that would block path of wire)
-tracheal stenosis
-infection: ludwigs angina
-coagulopathy
37
how do you retrograde place
-puncture CTM with 14g needle
-aspirate air to confirm in trachea
-pass wire cephalad and out of mouth
-clamp wire, load ett and advance
-once ett cannot be advanced anymore, withdraw wire and advance ett to final position
38
nasal intubation c/i
lefort ii, iii
basilar fx
coagulopathy
nasal fx (cribiform plate fx)
39
nasal intubation depth
men 27
women 25
40
who is bullard laryngoscope good for
small mandible
-pierre robin, goldenhar, treacher collins, cri du chat
limited mouth opening (need at least 7 mm)
limited c spine mobility
41
c/i to bullard laryngoscope
none
42
who is the bullard great for
PEDS - bullard is faster than FOB- less cervical displacement than DL
43
where does the ETT sit with bullard
to the R of the blade
44
should you have pt in sniffing position with bullard
no
45
bullard laryngoscope how do you increase glottic exposure
life anterior
46
symptoms of epiglottitis
4 d's: drooling dyspnea dysphonia dysphagia
47
epiglottitis is the #1 cause of
meningitis < 5
48
is croup viral or bacterial
viral
49
ludwigs angina
cellulitis infection of submandibular space from dental abscess-> complete upper airway obstruction
50
how to intubate ludwigs angina
need awake FOB or nasal intubation
retrograde intubation C/I
51
larygeal papilloma
benign neoplasm from hpv
52
cystic fibrosis is a mutation of what
chloride regulation mutation- tenacious mucus/ secretion production in lungs, liver, pancreas, gi tract
53
is cystic fibrosis obstructive or restrictive
obstructive
54
what other comorbid are common with CF
DM and hepatitis- check BG and coags
55
what is the number 1 risk for viral infection following blood transfusion
cytomegalovirus
56
alpha 1 antitrypsin deficiency
-early onset 25-50 yo COPD like emphysema from liver not producing alpha 1 antitrypsin
-leads to loss of elastic recoil, alveolar tissue destruction, airway collapse, and air trapping
57
PISS vs DISS
piss- wrong cylinder
diss- wrong pipeline
58
what are the numbers for oxygen, air and n2o
air= 1,5
n2o= 3,5
o2= 2,5
59
what does the oxygen analyer do
-detects pipeline crossover / flowmeter leak
-o2 analyzer = inspiratory limb
60
o2 pressure failure device
o2 pressure, not concentration
61
what is o2 consumption
250 ml/min
62
jet ventilation
15-30 psi via 14g needle cric
63
o2 flush valve
35-75 L/min at 50 psi
64
when do the bellows move
during expiration
-ascending bellows rise during expiration
65
soda lime turns purple at what pH
10.3
66
what si the most sensiitve indicator of absorber exhaustion
elevated fico
67
what inhibits hpv
mac >1.5, vasodilators (ntg, snp), pde inhibitors, dobutamine, ccb, acei
68
what is in the aldrete score
activity, neuro status, oxygen sat, respiration, circulation
69
what ones contain gastric ports
igel, supreme, proseal
70
what blade is the modified mac with levered tip to lift up epiglottis
mccoy
71
what blade is straight blade with wider spatchula/ belly
wisonsin
72
what blade is straight blade with side overhang best for cleft palate
oxford
73
what blade is modified mac with steeper 135 degree mount angle for limited neck mobility and lg breasts
polio
74
look at pics of lmas
Fast Trach = Intubating
I Gel = Spontaneous breathing, no cuff
Supreme = Single use, Gastric Tube, Bite Block
ProSeal = Reusable, Gastric Tube, Bite Block
Protector = Cuff Pilot allows pressure monitoring
Gastro = Helps passage of Endoscope
Air-Q
75
what lmas are safe for mri
lma classic, supreme, igel
76
what materials are safe for mri
stainless steel, titanium, aluminum and copper
77
most likley cause of injury with LMA placement
cuff overinflation
78
how does a nebulizer work
venturi
79
where should the hme filter be placed on a known patient with active infection/ pathology
expiratory limb
80
where is precordial placed
between 2 and 4th interspaces L sternal border
81
what does cbf autoregulate at
50-150
82
cmro2 decreases _ for every 1 degree of hypothermia
7%
83
#1 site for herniation
temporal uncus (CN 3 oculomotor)
84
is peep good or bad for high icp
bad - avoid it
85
how fast should you get tpa or embolectomy for ischemic stroke
tpa w/in 4.5 hrs. embolectomy w/in 6
86
what is tripple h therapy for SAH
hemodilution (hct < 30%), hypervolemia, HTN
87
how to reverse warfarin
ffp, prothrombin complex, factor 7a
88
what should you avoid for tbi
steroids! glucose, albumin, n2o, hyperventilation
89
what anticonvulsants cause resistance to NDMR
phenytoin, valproic acid, carbamazepine
-cyp 450 inducers
90
s/e of abrupt withdrawl of gabapentanoids
seizures
91
s/e of carbmazepine
aplastic anemia
92
s/e of valproic acid
bleeding/ hepatic toxicity
93
tx for alzheimers
cholinesterase inhibitors
94
fxn of cholinesterase inhibitors
inhibits pche - prolonged doa of sux
95
whats wrong with parkinsons
low dopamine and excess ach. excess gaba at thalamus-> eps
96
s/s of parkinsons
pill rolling, skeletal muscle rigidity, postural instability and bradykinesia (slow movements)
97
what drugs do you want to avoid for parkinsons
metoclopramide, droperidol, haloperidol, promethazine
98
andidopaminergics and muscle relaxants
have no effect on sux or ndmr
99
risks of deep brain sitmulator
tx for parkinsons
sitting position- risk of VAE (precordial dopler for monitoring)
100
what si the only CN in the CNS not in pns
cn 2 optic
101
cn 3 oculomotor controls what eye movements
all except LR6 SO4
102
ischemic optic neuropathy
#1 periop vision loss
from cn2
hypotension in prone
risks: prone, wilson frame, long surgery, lg blood loss, low colloid ratio, hotn
pt risks: male, obese, DM, HTN, smoking, elderly, HLD
103
central retinal arterial occlusion
external compression on globe in prone position
risks- horeshoe headrest in prone
104
#1 eye complication
corneal abrasion
105
how long after spinal cord injury should you avoid sux
24 hrs
106
does MG have normal ach
yes normal ach but dec number of receptors
107
s/s of MG
muscle weakness that progresses as day goes on; resp weakness is #1 concern
108
when do you need post op vent for MG
MG >6 yrs, pyridostigmine >750 mg/day, vc <2.9 L, copd, sternotomy
109
tensilon test
edrophonium 1 mg IV-> weakness worsens= cholinergic crisis- give anticholinergic
if weakness improves= MG crisis- inc ach at NMJ- improved strength
110
MG and NMB
restatnt to sux -inc dose
sensitive to ndmr- reduce dose by 1/2
111
eaton lambert
autoimmune destruction of pre synaptic ca channels- dec ach release
skeletal muscle weakness-> s/s similar to MG
tx: 3,4 diaminopyrodine- inc ach release from pre synaptic terminal
112
eaton lambert and nmb
sensitive to sux and ndmr
113
MS
demyelination of cns- autonomic instability, bulbar weakness, aspiration risk, sensory deficit
114
MS and muscle relaxants
sensitive to ndmr
avoid hypothermia and sux -> hyperkalemia in MS (hypothermia prolongs sux)
115
guillian barre syndrome and neuromuscular
avoid sux- hyperkalemia (extrajunctional receptors)
GBS- sensitive to NDMR
116
guillian barre
autoimmune destruction of myelin in nerves- from ebstein barr virus- starts with a flu like symptoms-> ascending paralysis-> resolves (tx iv iggg)- no steroids
117
mh is associaed with which dz
king denborough syndrome, central core, multi core dz
118
mh tx
-cool them <38 c and correct acidosis - sodium bicarb 1-2
-correct hyperK- cacl 5-10 mg/kg, insulin 0.15 u/kg / d50 1 ml/kg
- dx dysrhtyhmias - lido 2 mg/kg / procainamide 15 mg/kg - no ccb
-uop > 2 ml/kg/hr = fluids, mannitol 0.25 g/kg, lasix 1 mg/kg
119
cobb angle of what = surgery
40-50
120
myotonic dystrophy
no sux (sustained contractions), anticholinesterases, hypothermia with myotonic dystrophy
121
where are third order neurons located (hot spot)
thalmus conencting to cerebral cortex
-1st order: SC
2nd: brainstem
3rd: thalmus
122
how do these drugs effect seizures?
ketamine
propofol
etomidate
methohexital
lidocaine
ketamine- induces seizures
propofol- reduces seizures
etomidate- induces seizures
etomidate- induces seizures
methohexital- no effect on seizures
lidocaine- reduces seizure threshold/ decreases duration
hyperventilation / hypocapnia will inc seizure duration
123
a wave form on cvp correlates to what part on ekg
p wave
RA cxn
124
c wave on cvp correlates to what part on ekg
rv cxn
qrs (isovolumetric cxn)
125
x on cvp correlates to what part of ekg
ra relaxation
end of qrs / t wave
126
v wave on cvp correlates to what part on ekg
ra passive filling
end of t wave
127
y descent
RA empties to LV (mv opens)
t-> p wave
128
best leads for ischemia/ arrhythmias
lead II and V5
129
where does hydralazine work
ccb - works in arteries
130
antiarrhythmic drug classes
class 1: na blockers- lidocaine, procainamide
class 2: beta blockers
class 3: k blockers- amiodarone
class 4: ca blockers- diltiazem, verapamil, clevapine
131
who needs endocarditis abx prophylaxis
prior ie infection, prostethic ht valve, unrepaired cong ht defect < 6 m old, gingival/ resp infection biopsies, ht tx with valvuloplasty
132
who does not need abx prophylaxis
cabg, mv prolapse, coronary artery stent
133
heparin goal before cpb
>400
134
who needs retrograde plegia
incompetent aortic valve
135
#1 cause of death with LVAD
sepsis
136
transcranial doppler
looks at flow through middle cerebral artery
137
which physiologic factors increase after placement of infra renal aortic cross clamp?
preload and mixed venous o2 sat
138
where is lead v5 placed
5th ICS L anterior axillary line
139
what a line placement is most reflective of central/ aortic pressure
femoral
140
most common vessel cannulated for retrograde cardioplegia
coronary sinus= middle vein
HOT SPOT
141
what leads monitor ischemia to anterolateral heart
lateral= 1, avl, v5, v6
anterior= v1-v4
142
efficacy
potency
affinity
potentiation
efficacy- ability of drug to produce effect
potency- dose needed for effect
affinity- ability of drug to stimulate a receptor
potentiation- drug A is efficacious when given with B. drug A owould not work if given alone
143
bronchial blockers- can they be used to isolate contralateral lung infection
NO
144
can bronchial blockers be used for nasal intubation
yes
145
cross clamp- increase.. vs decreases..
increases MAP, svr, svo2, pao2, o2 consumption, coronary bf
decreases renal bf
146
cross clamping of Artery of adamkiewicz
becks syndrome- anterior spinal a syndrome
-flaccid paralysis of LE- corticospinal tract
-bowel and bladder dysfunction- autonomic nerves
-loss of temp and pain sensation- spinothalamic tract
-touch and proprioception is sparred!!! - dorsal column
147
what is the first shock with pals
2 J/kg
148
what does phospholipase c do
vasoconstriction
149
nitric oxide pathway
L arginine-> NO-> guanylate cyclase -> cGMP-> sm muscle relaxation
150
what factors increase after infra renal aortic cross clamp?
-preload
-mixed venous oxygen saturation
151
clearance is inverse to
half life and concentration
152
clearance is directly r/t
extraction ratio, blood flow, dose
153
a lipophilic drug has what vd
>0.6 L/kg
154
a hydrophilic drug has what vd
<0.6 L/kg
155
what is pka
ph where drug is 50% unionized and 50% ionized (conjugated acid)
156
what has the greatest effect on degree of ionization for drugs with pKa closest to physiologic pH
small changes in pH
157
ionized fraction predominates if
wb in acidic solution. wa in basic solution
hydrophilic and lipophobic
no diffusion across bbb, less hepatic biotransformation, more renal elimination
158
non ionized fraction predominates if
wb in basic solution
wa in acidic solution
lipophilic and hydrophobic
crosses BBB
more hepatic biotransformation
less renal elminiation
159
examples of zero order kinetics
more drug than enzymes
asa, phenytoin, etoh, warfarin, heparin, theophylline
160
drug metabolism phase 1
modification
-oxidation- removing electron
-reduction- adding
hydrolysis- adds water to split apart (esters)
161
phase 2 metabolism
conjugation
adds highly polar, water solube substrate
162
example of glucuronidation
morphine (falls under conjugation)
163
phase 3- elimination
atp dependent carrier proteins transport across cell membrane produced by kidney, liver, GI tract
164
enzyme inducers examples
etoh, tobacco, phenytoin, rifampin, barbituates
higher dose of other things needed
165
enzyme inhibitors
grapefruit, ssris, erythromycin, cimetidine, azole antifungals, omeprazole
lower dose needed
166
what is eliminated by pseudocholinesterases
Ester LA, succ, mivacurium
167
what is eliminated by nonspecific esterases
esmolol, remi, atracurium, clevapine, etomidate
168
what NDMR is excreted biliary
rocuroniujm
169
what enzyme metabolizes inhalation agents
CYP2E1
170
is it faster on/off if the blood: gas is higher or lower
lower- less gas in the blood
171
blood: gas tells you what
onset
172
oil gas tells you what
potency
173
decreased oil gas means
low potency
174
what gases cause hepatic dysfunction
iso, des, halothane
175
concentration effect
overpressurizing- higher concentration of agent to produce faster rate of rise
176
ventilation effect
as rate of rise increases, alveolar ventilation decreases as self protection- decreasing fa/fi rate of rise
177
low solubility of a gas means
faster onset -faster fa/fi equibiliriation
178
higher solubility of a gas means
slower fa/fi equilibriation- slower onset
179
rate of hepatic biotransformation and pulmonary (alveolar) metabolism
n2o 0.004%
des 0.02%
iso 0.2%
sevo 2%
halo 20%
180
best to monitor for intubation
facial n: orbicularic occuli (eye lid), corrugator supercilli (eyebrow)
181
recovery from nmb best to monitor
ulnar n and tibial n: adductor pollicis (thumb) and flexor hallucis (toe)
182
how many receptors are blocked if tv is > 6 mL/kg
80%
183
how many receptors are blocked if vc is > 20 mL/kg
70%
184
how many receptors are blcoked with tof 4/4 w/o fade
70-75% blockade
185
how many receptors are blocked with inspiratory force > -40
50%
186
best indicators of recovery from nmb
tetany > 5 seconds, headlift > 5 seconds, hold tongue blade against force
187
other names for pseudocholinesterase
plasma cholinesterase, butrecholinesterase, pseudocholinesterase, t2, false pche
188
extraunctional receptors
reduced pche- hyperk and prolonged action of sux
189
what has inc sensitivity to sux
guillian barre, ms, huntingtons, als, eaton lamberts
190
what is resistant to sux
mg
191
how much does sux inc k
0.5- 1 for 10-15 mins - hyperkalemia
192
dibucaine number
inhibits normal pche - tests for degree of functional pche avaliable
193
dibuacine of 70-80
typical homozygous - normal- DOA 5-10 mins
194
dibucaine of 50-60
heterozygous - DOA 20-30 mins
195
dibucaine of 20-30
atypical homozygous- DOA 6-8 hrs
196
which ndmr are aminosteroids
roc, vec, pancuronium
197
potency most to least
CPAR - cis, pancutonium, atracurium, rocuronium
198
what drugs produce laudanosine
atracurium and cisatracurium
seziures!!
199
pancuronium s/e
inc hr
200
acetylcholinesterase
breaks down ach atb NMJ or nicotonic receptors
201
acetylcholinesterase inhibitors
indirectly inc ach at receptor/ blocks hydrolysis
inhibit action of pchE = prolongs sux
202
anticholinergics
antagonize muscarinic/ cholinergic effects of ache inhibitors (sympathetic response)
203
what anticholinergics are tertiary
atropine, scopalamine
204
#1 anticholinergic for tachycardia
atropine
205
#1 anticholinergic for motion sickness and sedation
scopalamine
206
#1 anticholinergic for antisalagogue
glyco
207
a delta fibers
fast sharp pain temp
208
c fibers
slow dull pain
209
transmission
1st order neuron: dorsal horn/ dorsal root ganglion
2nd: dorsal horn-> thalamus
3rd: thalamus to cerebral cortex
210
what inhibits pain
gaba and glycine release
211
where is pain processed and percieved
cerebral cortex and limbic system
inhaled anesthetics and alpha 2 agonists
212
what part of opioid does anti shivering
kappa agoinst (dynorphin)
213
what does mu agonist do
endorphin- resp depression, brady, miosis, constipation
214
what is delta agonist
enkephalin
215
can you use remi in intrathecal
no! contains glycine powder
216
s/e of methadone
prolonged QT syndrome-> torsades
217
iv dose and potency
meperidine
morphine
hydro
alfentanil
remi
fentanyl
dose; potency
meperidine: 100 mg 0.1
morphine: 10 mg 1
hydro: 1.4 mg 7
alfentanil 1000 mcg 10
remi 100 mcg 100
fentanyl 100 mcg 100
218
what does pka mean
onset
219
what does solubility mean
potency
220
what does protein binding mean
doa
221
closer pka to blood ph=
faster onset
222
benzene ring
lipophilicity
223
intermediate chain
allergy potential!!
drug class
metabolism
224
tertiaryb amine
makes it a weak base
225
what drugs cause methemoglobinemia
benzocaine, emla cream, cetacain
226
which way does methemoglobinemia shift curve
L
tx: methylene blue 1-2 mg/kg
227
what increases risk of methemoglobinemia
g6p reductase deficiency and neonates
228
what is emla cream
2.5% lido and 2.5% prilo
229
what type of LA has cross sensitivity and allergy potential
ester (PABA)
230
is chloroprocaine protein bound
no
231
benzocaine at physiologic ph
unionized pka 3.5
232
la uptake based on location
iv > tracheal > intrapleural > intercostal > caudal > epidural > Brachial plexus > femoral : sciatic, sub q
233
which way should you look during retobulbar block
midline- highest risk of hemorrhage
234
how long should you wait before and after exparel for lidocaine
after lido- no exparel for 20 mins
after exparel- no lido for 96 hours
235
are LA weak acids or weak bases
weak bases
236
what do LA bind to
conjugated acid binds to intracell alpha subunit of na channel
unioniezed base (LA) and conjugated acid (LA+) - cross axolemma- enter acitve channel- intracell portion of active na alpha subunit- na channel remains closed/ inactivated until LA diffuses away
237
max dose of lido during tumescent anesthesia
55 mg/kg
238
when should GA be used for tumuscent anesthesia
>2-3 L of tumescent
239
what is ebl with tumescent anesthesia
5% of removed fluids
240
most common cause of death with tumuscent anesthesia
PE
241
additives to LA that prolongs doa
decadron, epi, dextran
242
additives to LA that shorten onset
bicarb
243
additives to LA that add analgesia
epi, clonidine, opioids
244
LA DOA
short: procaine, chloroprocaine
intermediate: lido, mepivicaine
long: bupiv, ropiv, tetracaine
245
what is the dose of intralipids
1.5 ml/kg 20% intralipids if < 70 kg
> 70 kg 100 ml bolus
double and repeat 2x
246
max dose of intralipids
max 12 ml/kg
247
what dose should epi be kept under for LAST
< 1 mcg/kg
248
placing lidocaine in what kind of solution inc its degree of ionization
acidic; water soluble and lipophobic
249
last symptoms in order
resp depression, arrythmia, loc
250
esophogeal stethoscope depth
28-32 cm- heart of breath sounds depending on depth
251
what should esophogeal doppler be at
35 cm or t5-t6 or 3rd sternocostal space - where esophagus and descending aorta line up
252
where is conus medularis in adults / peds
L1-L2 in adults
L3- peds
253
when do you d/c clopidogrel and ticlopidine before neuraxial
clopidogrel - 7 days
ticlopidine- 14 days
asa and heparin are safe
254
LA blockade order
b- c- a delta- a gamma- a alpha and a beta
255
a alpha
motor
256
a beta
touch and pressure
257
a gamma
muscle tone
258
a delta
fast pain and temp and touch
259
b fiber
preglanglionic and myelinated - site of spinal action
260
c fiber
post galgnionic unmyelinated - sympathetic- slow pain
261
block motor, sensory and autonomic
motor
sensory 2 higher
autonomic 2-6 higher than sensory
262
what impacts spinal spread
baricity, dose, site of injection, positioning
263
what is the bone most likely to hit during paramedian
vertebral lamina
264
what is blocked during epidural (and what levels)
sensory 1st-> motor -> NO automatic
sensory 2-4 higher than motor
265
what affects epidural spread
volume concentration and dose
266
what is the dose for epidural ___ per segment blocked
1-2 mL
267
what are better for pdph
sprotte and whitacree - pencil point
268
what block can be used for pdph
sphenopalantine
269
what ligament covers sacral cornu (important for caudal block)
saccrococygeal ligament
270
dose of caudal block for circumcision/ hemorrhoidectomy
0.5 ml/kg
271
where do you want to block to for caudal block
t10 = 1 ml/kg
272
what is c6
thumn
273
what is c7
2nd and 3rd digits
274
what is c8
4th and 5th digits
275
what is t4 and what surgeries block here
nipple line- upper abd surgery, c section, cystectomy
276
t6
xiphoid process- lower abdomen surgery- appendectomy
277
t10
umbilicus- total hip, vaginal delivery, turp
278
t12
pubis
279
L1-L2
lower extrem surgery
280
L2-L3
foot surgery
281
L4
anterior knee
282
s2-s5
hemorrhoidectomy
283
what surgery is isc block really not good for
forearm/hand- c8-T1 often misses medial proximal upper arm
284
what nerve causes phrenic n. block
c5 block- hemiparalysis of diaphragm
285
what nerve causes horner syndrome
c7- stellate ganglion block- ptosis, miosis, anhidrosis
286
what reflex can be caused with ISB
hypotension and bradycardia in sitting posittion and isb- bezold jarish
287
supraclavicular
trunks and divisions- upper arm, elbow, forearm, wrist and hand - NOT SHOULDER
forearm big
288
biggest risk with supraclavicular block
pneumothorax
if pt has cough, dyspnea, chest pain- xray
can still get horners, subclavian hematoa
289
