Flashcards in Anatomy Deck (45)
What landmark is used to determine the proper location for a lateral femoral cutaneous nerve block? When might this block be indicated?
2. Skin grafting to this area of the thigh, or muscle biopsies in children
Which block (infraclavicular or supraclavicular) poses the greatest risk for PTX when using an ANATOMICAL LANDMARKS approach?
What is the most common complication of a Supraclavicular nerve block? What is the most serious complication?
1. Most common: phrenic nerve block
2. Most serious: PTX
Describe the differences between a pediatric airway and an adult airway:
1. Larynx is at C3-C4 instead of C4-C5
2. Epiglottis is omega or "u" shaped, it is narrow and curved as opposed to a flat and large epiglottis
3. The tongue of an infant is larger
4. The vocal cords are more anterior
5. The narrowest area of the airway in a kid is the cricoid cartilage
What muscle is targeted in the jaw lift maneuver?
The genioglossus muscle
Where does the great spinal artery, or artery of adamciewicz come off of? What would transection of this artery present like in a patient?
2. Bilateral LE paralysis and bladder/bowel dysfunction. Sensation and proprioception would be spared because there are TWO posterior spinal arteries, compared to just ONE anteriorly
Where can you successfully block the saphenous nerve in an ankle block?
ANTERIOR to the MEDIAL malleolus
At what omniplane can you obtain the ME two chamber view vs. the ME commissural view?
1. ME two chamber is omniplane 90 degrees
2. ME commissural view is omniplane 60 degrees
How do you identify the anterior mitral valve in the ME 4 chamber view, the ME two chamber view (at 90 degrees) and the ME commissural view (at 60 degrees), and the ME LAX view?
1. ME 4 chamber (omniplane 0): anterior mitral valve is closes to the atrial septum
2. ME 2 chamber view (omniplane 90 degrees): anterior mitral valve is closest to the atrial appendage
3. ME commissural view (omniplane 60 degrees): anterior mitral valve is flanked by the posterior valves
4. ME LAX (omniplane 120): anterior mitral valve is closest to the aorta
What are the landmarks for the infragluteal sciatic nerve block? When can this block be used?
1. Landmarks: greater trochanter, ischial tuberosity, and the sciatic groove. The greater trochanter and the ischial tuberosity are identified and a line is connecting the two. Another line is drawn perpendicular to and in the middle of that line that extends 3-5 cm. This will give you the sciatic groove, which can be palpated and is the site of injection.
2. Use this to numb the posterior thigh or all structures at or below the knee
What three nerves run within the axillary sheath? What nerve runs outside of it?
1. Radial (posterior), Median (lateral), ulnar (medial)
2. Musculocutaneous runs outside of the sheath
Which nerve supplies the SENSORY function the epiglottis, arytenoids, aryeepiglottic folds, and the base of the tongue? How can it be identified? When might a block of this nerve be useful?
1. INTERNAL branch of the SUPERIOR laryngeal nerve
2. It is aterocaudal to the cornu of the hyoid bone (pierces the throhyoid membrane)
3. This can be blocked when doing an awake fiberoptic intubation
What is on your differential for a one sided epidural block?
1. dural fold connecting the dura to the ligamentum flavum
2. Not enough local
3. Insertion of the catheter > 5cm into the epidural space. In this case, pulling the catheter out 1-2 cm will give you a better block
What coronary artery supplies the posteromedial papillary muscle?
What walls does the RCA supply?
The RCA covers
1. the posterior 1/3 of the inter ventricular septum
2. The inferior wall of the LV and RV
What walls does the Lcx artery supply?
The Lcx supplies:
1. inferolateral wall
What walls does the LAD supply?
The LAD supplies the
1. anterolateral wall
2. anterior wall
3. RV anterior wall
4. anterior 1/3 of the inter ventricular septum
Where do the conus medullaris and dural sac end in adults vs. infants?
1. Adults: Conus ends at L1 and the dural sac ends at S1
2. Kids: conus ends at L3 and the dural sac ends at S3
What muscle does the musculocutaneous nerve course through?
What nerve supplies the motor function of the tongue and can be damaged with LMA placement?
The Hypoglossal nerve
What nerve can you anesthetize for awake intubation, by piercing the cricothyroid membrane?
The recurrent laryngeal nerve, which supplies the vocal cords and the trachea
What ECG changes do you see with intravascular LA injection?
Prolonged QT, prolonged PR, elevated T waves, bradycardia, and arrest
What effect does spinal anesthesia have on hearing?
It can transiently decrease hearing, esp in F for 1-3 days
What effect does spinal anesthesia have on bowel function?
Due to the unopposed PS signal, you can get diarrhea and increased gut motility
What is the major landmark for blocking the stellate ganglion?
The TP of C6
Which two nerve fibers mediate nociception? What are there sizes/myelination status? Which is fastest?
1. A-delta and C
2. A-delta is large and myelinated, C is small and Demyelinated
3. A-delta is faster than C
*A-delta is the sharp, immediate pain, whereas C is the dull pain
Describe the differences in spinous processes seen between the Thoracic and Lumbar vertebrae
The Lumbar SP are larger and stick out straight, where as the thoracic SP are smaller and more angulated downward
What is the first line treatment for severe hypotension and bradycardia associated with a high spinal blockade?
1. IV epinephrine
What artery supplies the AV node?