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Regional 540 - PM > centroneuraxial > Flashcards

Flashcards in centroneuraxial Deck (61):
0

how many vertebrae in cervical

7

1

how many vertebrae in thoracic

12

2

how many vertebrae in lumbar

5

3

how many vertebrae in sacral

5

4

how many vertebrae in coccygeal

4

5

what are the high points?

L3-L4

6

what are the low points

T4

7

the spinal cord extends to __ in the adult and __ in the newborn

L1 adult

L3 newborn

8

the lateral approach DOES NOT pass through which two structures?

supraspinous and interspinous ligaments

9

the spinal cord is enlarged in two sections, one is called the cervical enlargement but actually forms the Brachial plexus (from __ to __), the other is the lumbosacral enlargement forms the lumbosacral plexus (from __ to __)

brachial plexus C5-T1

lumbosacral L2-S3

10

name the three meninges from outside in

dura
arachnoid
pia

dap

11

the distance from the skin to epidural space using a midline approach is __ to __ cm, with an average of 5 cm

2.5 - 8 cm

a 3.5" epidural needle is 8.9 cm long

12

the principal site of action for neuraxial block is the __

nerve root

13

scoliosis is a __ curvature

lateral

14

kyphosis is a __ curvature

excessive posterior
"hump" in thoracic region

15

lordosis is __ of the back due to obesity or pregancy

hollowing

16

what level for a c-section?

T4

17

belly button is at level

T10

18

inguinal is at level __

T12

19

what is the first fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?

B, autonomic, to blockages.

20

what is the second fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?

type C, pain, 0.4-12 microns, NO myelin, 0.5-2.3 m/s, ++++ sensitive

If I was on Hep "C" precautions "secondary" to a needle stick, even if it only penetrated 0.4-12 microns, I could have "NO" sex for 1/2 to 2.3 years and would have "++++" pain.

21

what is the third fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?

type A, many functions, 2-20 microns, heavy myelin, 12-120 m/s, increasing sensitivity.

Three type A people I know do almost everything from age 2-20, even lifting heavy weights 12-120 pounds with increasing sensitivity

22

type A alpha

proprioception, motor

23

type A beta

touch, pressure

24

type A gamma

muscle spindles

25

type A delta

pain, temp

26

how to remember the type A fibers in order

I knew the car was motoring too fast, so I first touched then put pressure on the brakes, then muscled it as much as I could, but I crashed and now have a lot of pain and a fever.

27

what happens when you block B fibers?

venodilation and hypotension

your *B*lood pressure drops when you block your *B* fibers

28

what happens when you block your C and A-delta fibers?

loss of pain and temp

remember, if I get a needlestick and am on Hep C precautions, or if I wreck my car, it's going to be very painful and my temp will go up

29

what happens when you block type A-gamma fibers

loss of muscle

remember, you're muscling the brakes as much as you can to prevent a crash

30

what happens when you block type A-beta fibers

touch and pressure

remember, you first touch then apply pressure to the brake

31

what happens when you block type A-alpha fibers

loss of motor and proprioception

you "knew" the car was "motoring" too fast

32

where are your cardiac accelerator fibers?

T1-T4
profound bradycardia

33

Motor block occurs __ segments __ than sensory block

2-3 segments LOWER

34

sympathetic block occurs __ segments __ than sensory block

2-6 segments HIGHER

35

INR 1.2-1.5 = __

NO GO!!

36

Aspirin and NSAIDs

not a problem

37

heparin

need normal PTT, can heparinize 1 hour post catheter removal

38

coumadin

need INR less than 1.5 to perform or remove

39

report new lower limb weakness, sensory deficit, bladder/bowel dsfxn, back pain

IMMEDIATELY

need surgical decompression of hematoma!

40

most common complication?

second most common complication?

Backache 1
headache 2

41

etiology of post dural puncture headache

decreased CSF drops brain into foramen magnum, stretches meninges and vessels on top, leading to HA

42

treatment for PDPH as evidenced by bilateral FRONTAL pain from eyes posterior to occiput then caudad down neck

caffeine, fluids, bed rest, NSAIDs, epidural blood patch, DON'T LET THEM GO HOME!!

43

how to prevent PDPH

smallest pencil point needle, bevel sideways, straight in, avoid young or females, don't dull needle on bone, use weak anesthetic, preferably tetra over bup

44

where would you give an epidural blood patch?

one level LOWer because blood will spread rostrally (cephalad)

45

tell me about the intercristal line

the plane across the top of the iliac crests, usually intersects L4-L5

46

taylor's approach- _ cm medial and _ cm caudad to posterior superior iliac spine, angle medially and cephalad 55* toward L5 interspace

1
1

47

how much CSF do adults make each day?

500 ml

48

normal CSF pressure

10-20 cmH2O

49

how much CSF in the subarachnoid space, central canal, and brain at any given time?

how much in spinal canal only?

140 ml

30-80 ml

50

spec grav of CSF

1.004-1.009

51

HYPERbaric solutions have a spec grav __ than CSF and will thus sink to the lowest point

greater than

52

HYPObaric solutions have a spec grav __ than CSF and thus float or rise to the top

lower

53

how to make a HYPERbaric solution- dissolve in __, makes a baricity > 1

dextrose

54

how to make a HYPObaric solution- dissolve in __ water, makes a baricity < 1

sterile

55

how to make an isobaric solution

dissolve in CSF or NS

56

Highly protein bound drugs such as __ and __ last longer than those that aren't like lidocaine

tetra and marcaine

57

distribution of local anesthetic in CSF is influenced by 4 things

baricity
concentration
position
contour

*B*e*C*ause *P*osition *C*ounts

58

dysfunction of bowel or bladder, think

cauda equina

59

severe back pain think

transient neurological symptoms

60

n/v occurs due to unopposed parasympathetic activity and __

hyperperistalsis