1. Bier Block

Question 1

BB Advantages

Answer 1

bloodless field
easy
fast onset
fast recovery
muscular relaxation
control of anesthesia

Question 2

BB disadvantages

Answer 2

systemic SE
time-limited
uncomfortable

Question 3

BB indications

Answer 3

distal/superficial extremity
- carpal tunnel
- ligament/tendon

Question 4

BB limitations

Answer 4

• must be inflated 15-20 mins
• no analgesia once cuff is down
• short duration (45-60 min)
• tourniquet pain

Question 5

BB absolute CI

Answer 5

1. no bupi or ropi
2. no epi
3. infection
4. pt refusal
5. allergy to local

Question 6

what drugs can you not use in BB?

Answer 6

bupivacaine
ropivacaine
epinephrine

Question 7

BB relative CI

Answer 7

1. raynauds
2. beurgers
3. homozygous sickle cell
4. ischemic limb

Question 8

IV LA systemic absorption (fastest to slowest)

Answer 8

FASTEST
IV/Arterial
Tracheal/Transmucosal
Intercostal
Paracervical
Epidural/Caudal
Brachial Plexus
Sciatic
Sub Q
SLOWEST

I TIP EB SS

Question 9

5 factors that slow LA absorption

Answer 9

1. injection site
2. additives (epi)
3. high lipid solubility
4. incr dosage
5. incr volume of dist

Question 10

Amide hydrolysis
(Short to long acting)

Answer 10

SHORT
Prilocaine
Lidociane
Mepivacaine
Ropivacaine
Bupivacaine
LONG

PLMRB

Question 11

LA SE

Answer 11

Circumoral/tongue numbness
Lightheadedness
Unconsciousness
Seizures
Tinnitus
Eyesight
Respiratory arres

Fibrillation
Urticaria
CV collapse

Muscle twitching
Altered mental state
Slurred speech
Seizure

Question 12

LAST Symptoms

Answer 12

1. seizure
2. hypotension
3. arrhythmias
4. resp distress
5. cardiac arrest

SHARC

Question 13

LAST treatment

Answer 13

1. intralipid
2. vent support
3. cardiac support
4. seizure suppression

Question 14

intralipid dosing

Answer 14

1.5-3 ml/kg

Question 15

LAST cardiac drugs/dosing

Answer 15

10-100 mcg epinephrine

Question 16

seizure suppression drugs

Answer 16

versed
propofol
pentothal

Question 17

hand/forearm BB dosing

Answer 17

3 mg/kg of 0.5% lido

Question 18

cuff below knee BB dosing

Answer 18

50 mL of 0.25% lido

Question 19

cuff on thigh BB dosing

Answer 19

100 mL of 0.25% lido

Question 20

BB surgical anesthesia

Answer 20

5-10 mins

Question 21

BB tourniquet pain

Answer 21

20-30 mins

Question 22

in what order do you inflate the cuffs for a BB

Answer 22

distal
then
proximal
then deflate distal

Question 23

how long should you monitor pt for LAST after taking down cuff

Answer 23

5-10 mins in OR

Question 24

after how long can you take cuff down without stressign about LAST

Answer 24

40 mins

Question 25

how long does the cuff have to stay up after injection of LA

Answer 25

15-20 mins

Question 26

what can you do if you need to take the cuff down early?

Answer 26

bounce the cuff eval for LAST deflate cuff eval for LAST

Question 27

ester metabolism

Answer 27

psuedocholinesterase

Question 28

cocaine metabolism

Answer 28

liver

Question 29

amide metabolism

Answer 29

CYP450 enzymes liver

Question 30

ester metabolite

Answer 30

PABA (causes anaphylaxis)

Question 31

prilocaine metabolite

Answer 31

o-toluine (methemoglobinemia)

Question 32

which amide has the worst CV symptoms

Answer 32

bupivacaine

Question 33

what is similar to PABA

Answer 33

methyparaben preservative

Question 34

lidocaine hematology effects

Answer 34

decr thrombosis incr fibrinolysis

Question 35

excessive LA use causes

Answer 35

respiratory acidosis

Question 36

intralipid _______ the volume of distribution

Answer 36

increases the volume of distribution

Question 37

short LA block drugs

Answer 37

chloroprocaine

Question 38

medium LA block drugs

Answer 38

lido mepivacaine prilocaine

Question 39

long LA block drugs

Answer 39

procaine tetracaine bupivacaine ropivacaine

Question 40

what should you inflate the tourniquet to

Answer 40

2.5x systolic or systolic + 100

Question 41

what can you do if pt complains of tourniquet pain

Answer 41

inflate distal cuff deflate proximal cuff

Question 42

epinephrine contraindications

Answer 42

nose hose fingers toes