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Su: Sim Lab 2 > 31. Epidural > Flashcards

31. Epidural Flashcards

(57 cards)

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1
Q

epidural space

A

potential space between ligamentaum flavum and dura mater where fluids can collect

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2
Q

epidural space extends ______ to dural sheat

A

posterior
lateral
anterior

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3
Q

contents in epidural space

A

adipose
lymphatics
venous plexus
connective tissue

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4
Q

epidural indications

A

obstetric analgesia
surgical anesthesia
post-op pain control
chronic pain management

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5
Q

cervical epidrual

A

chronic pain steroid injections

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6
Q

thoracic epidural

A

post-op surgical pain

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7
Q

lumbar epidural

A

labor pain

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8
Q

caudal epidural

A

peds

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9
Q

how are epidurals controlled

A

LA dose
LA type
LA concentration
medication
location

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10
Q

dermatomes show

A

cutaneous sensory innervation

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11
Q

epidural CI: absolute

A

infection at site
pt refusal
coagulopathy
severe hypovolemia
incr ICP
aortic/mitral stenosis
sepsis

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12
Q

epidural CI: relative

A

neuro deficit
sepsis
mild stenosis
spinal deformity

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13
Q

what are we concerned about with anticoags and epidurals?

A
  • START/RESTART anti-coag while catheter is in?
  • time to DISCONTINUE anti-coag before REMOVAL of catheter
  • wait time to RESUME anti-coag
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14
Q

rivaroxaban trade name

A

xarelto

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15
Q

apixaban

A

eliquis

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16
Q

clopidogrel trade name

A

plavix

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17
Q

low dose heparin SC trade name

A

enoxaparin

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18
Q

LMWH trade name

A

lovenox

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19
Q

rivaroxaban (xarelto): wait ____ hrs after catheter removal

A

6 hrs

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20
Q

rivaroxaban: wait ____ hrs before removing catheter

A

22-26 hrs

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21
Q

apixaban: wait ____ hrs after cathether removal

A

6 hrs

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22
Q

apixaban: wait ____ hrs before removing catheter

A

26-30 hrs

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23
Q

clopidogrel: wait ___ hrs after catheter removal

Study These Flashcards
A

start immediately

24
Q

clopidogrel is not recommended when

Study These Flashcards
A

catheter in place

25
Low dose heparin: catheter can be removed when
4-6 hrs post dose
26
systemic heparin: remove catheter
1 hr prior to admin or wait 2-4 hrs after admin to remove
27
LMWH: 2x daily dose
4 hrs after catheter removal
28
can you give LMWH with catheter in?
no
29
LMWH: 1x daily
remove cather 12 hrs after last dose hold next for 4 hrs post removal
29
Cephalad spinous process
C7
30
cather too far in
one sided block
31
test dose epidural
3mL of 1.5% lido with 1:200000 epi
32
initial dose epidural
5 mL - 0.125% bupi - 2mcg/mL fentanyl
33
susequent doses epidural
5 mL 0.25% bupivacaine 2 mL fentanyl 3 mL NS
34
what sensory level are epidural blocking
T10-L1
35
C section epidural dose
20 mL 2% lido w/5mcg epi 4 mL 4.2% bicarb 2mL fentanyl ** give 5-6 mL of mixture
36
C- section epidural moprhine dose
1.5-2mg in 10mL w/saline
37
hip/Lower extremity sx ob anealgesiua
L2-5
38
colectomy upper abdominal
T6-T8
39
throacic
T2-T6
40
best choice for pre-incision for post-op pain epidural
50-100 mg 1% lidocaine + 50-100 mcg fentanyl
41
epidurals are ______ dose
volume dose
42
spinals are _____ dose
concentration dose
43
what makes PDPH better
laying down
44
PDPH duration
12-72 hrs
45
factors that incr risk of PDPH
younger female pregnant connective tissue disorder smaller habitus prior PDPH larger needle provider inexperience bevel lateral orientation
46
PDPH treatment: conservative
time lay down non-opioid analgeiscs fluids caffeine (300-500 mg)
47
PDPH treatment: invasive
blood patch sphenopalantine block
48
limit caffein to ____ if breastfeeding a low birth weight or premie
200 mg
49
what % of pts respond to blood patch
90%
50
what % of pts respond to second blood patch
90% of remaining 10%
51
what drug is used for spehnopalantine block
4% lido
52
hematoma treatment
surgical decompression
53
hematoma occurence
immediate
54
abscess occurrence
5 days to weeks after insertion
55
how to prevent abscess
bacterial filter less catherter manipulations replace every 96 hrs
56
sheared catheters can cause
abscess

Su: Sim Lab 2 (18 decks)

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