Military Upper Ext and other Stuff

Question 1

Answer 1

1. Roots
2. Trunks
3. Divisions
   4 Cords
   5 Superior
   6 Middle
   7 Inferior
   8 Lateral
   9 Posterior
   10 Medial
   11 Axillary
   12 Radial
   13 Medial
   14 Ulnar
   15 Musculocutaneous

Question 2

Answer 2

1. C6
2. C7
3. C5
4. C8
5. T1

Question 3

Answer 3

1. C8
2. C7
3. C6
4. C5
5. T1
6. C8

Question 4

Cervical plexus block are from what cervical nerves

Answer 4

C1-C4

Question 5

Interscalene blocks consist of what cervical nerves

Answer 5

C5-T1

Question 6

The intrescalene block is preformed at what level

Answer 6

C6 verterbral body

aka

Chassaignac’s Tubercle

Question 7

If C3 and C4 become blocked while doing an interscalene block what will your patient present with

Answer 7

Horner syndrome and hoarseness

Horner syndrome:

miosis

Anhydrosis

Pitosis

Question 8

Interscalene blocks always result in ________ because of the close proximity of the _______ to C3-C5?

Answer 8

Hemidiaphram paresis

phrenic nerve

Page 25 Military book

Question 9

Resp contraindication of intrascalene block would be

Answer 9

Any one unable to tolerate a reduction in pulmonary function of greater than 30 %

Question 10

What part of the bracheal plexus is involved in the interscalene blocks? Root, Trunk, cords, Divisions or Terminial branches

Answer 10

ROOT

Question 11

For an interscalene block how much Local is sufficient for the block

Answer 11

30-40 ml

Question 12

What surgery might the interscalene block not be useful for??

Answer 12

Hand and forearm specifically in the ulnar distribution becasue of its C8 and T1 origin. The local dosen’t spread that far caudal usually.

Question 13

Suprascapular Blocks what part of the Bracheal plexus

Answer 13

The Trunks:

superior

middle

Inferior

Question 14

At what level is it most likely to block ALL of the bracheal plexus?

CORDS

DIVISIONS

TRUNKS

ROOTS

???????

Answer 14

The Trunks because in this area the brachial plexus form 3 compact nerves in very close proximity to eachother.

Question 15

What nerves form the Superior trunk

Answer 15

Cervical nerve 5 and 6

Question 16

What nerves form the middle trunk

Answer 16

C7

Question 17

What nerves form the inferior trunk

Answer 17

C 8 and T1 nerve roots

Question 18

With the supraclavicular block what is the most frequent complication?

Answer 18

Pneumothorax

Question 19

What resp complication can the supraclavicular block have on the resp system besides a pneumo??

Answer 19

50% get a diaphramatic hemiparesis with minimal reduction in FRC

Question 20

How much Local is used in the supraclavicular block

Answer 20

30-40 ml

Question 21

Infraclavicular blocks involve what part of the brachial plexus?

ROOT

TERMINAL BRANCHES

CORDS

TRUNKS

DIVISIONS

Answer 21

CORDS

Question 22

Does the infraclavicular block produce respiratory depression

Answer 22

NO

Question 23

Using a twitch monitor which muscle is aceptable for appropriate postioning of the needle in a supraclavicular block??

Answer 23

extension or flexion of the digits

ulnar or median nerve

Question 24

Using a twitch monitor which muscle is aceptable for appropriate postioning of the needle in a infraclavicular block??

Answer 24

Finger and or thumb stimulation

Question 25

What is the most distal block preformed on the brachial plexus

Answer 25

The Axillary Block

Question 26

Advantages of the Axillary block

Answer 26

Can access the artery to hold pressure should a puncture happen, very little risk of resp issues related to the phrenic nerve or pneumothorax

Question 27

What are the terminal nerve branches of the brachial plexus

Answer 27

Axillary musculocutaneous radial median ulnar

Question 28

What nerve must be blocked separately if an axillary block is used

Answer 28

Muscuocutaneous

Question 29

Axillary blocks are use for what types of surgeries

Answer 29

Hand and forearm

Question 30

Supra and infra clavicualr blocks are used for blocks are use for what types of surgeries

Answer 30

elbow and uper arm surgery

Question 31

Positioning is key for an axillary block. Inability to do what would prohibit the use of this block

Answer 31

abduct the arm more than 45 degrees at the shoulder

Question 32

what must you have for a beir block

Answer 32

IV distal to the cuff

Question 33

This block is typically used for less then ____ minutes

Answer 33

60 min

Question 34

How high is the tourniquet pumped up to??

Answer 34

250 mm/Hg or 100 mm/Hg above the SBP

Question 35

In the double Lumen cuff which cuff is inflated first the proximal or distal?

Answer 35

Proximal because after 60 min tourniquet pain usually begins and the arm is numb under the distal cuff before you have to inflate it, reducing tourniquet pain.

Question 36

Amount of Local used for an upper ext beir block is??

Answer 36

30 - 50ml of 0.5% Lidocaine or about 3ml/kg