Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Principals Summer 2025 > Neuraxial 6/3 > Flashcards

Neuraxial 6/3 Flashcards

Test 1 (63 cards)

Start Studying
1
Q

______ is the LA with the highest risk for LAST

A

Bupivacaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What increases the risk for LAST? (3) Decreases? (3)

A

Increases: (CNS toxicity)
1. Hypercarbia
2. Hyperkalemia
3. Metabolic Acidosis

Decreases:
1. Hypocarbia
2. Hypokalemia
3. CNS depressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a secondary use of Bupivacaine & other LA? What considerations should we have w/ this?

A

Wound infiltration after Sx directly into the wound

Even tho the concentration is low (SQ), this amount still contribute to LAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

LAST normally happens __________ after admin of LA

A

immediately

(But response can also be delayed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the Tx for LAST? (5)

A
  1. Airway – 100% O2
  2. Tx seizures – use Benzos avoid propofol
  3. Modified ACLS – avoid epi
  4. Lipid Emulsion therapy
  5. Cardiopulmonary bypass (if previous unsuccessful)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the ACLS epi dose with LAST?

A

less than 1mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why do you avoid propofol with LAST?

A

Although its a lipid, it weakens the heart muscle

If its the only thing available –> use low dose 20mg increments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

You use ______ to Tx ventricular arrhythmias with LAST

A

amiodarone ONLY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the lipid emulsion therapy concentration & dose?

A

20%

> 70kg:
1) 100ml bolus for 2-3 mins
2) 250ml infusion for 15-20mins
3) Repeat bolus/double infusion if unstable

<70kg:
1) 1.5ml/kg bolus for 2-3 mins
2) 2.5ml/kg infusion
3) Repeat bolus/double infusion if unstable

  1. Continue infusion until 15 mins after stable

Max dose: 12 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the max dose for lipid emulsion therapy?

A

12 ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the 1st step in the LAST algorithm?

A

Call for help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medications do you want to avoid with LAST algorithm? (5)

A

Propofol
LA
Beta blockers
CCB
Vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are neuraxial associated hematomas associated with? (4)

A
  1. Indwelling catheters
  2. Long-term anticoagulation
  3. Abnormalities in clotting
  4. Traumatic needle placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

_______ is the most important factor with neuraxial hematoma. What is the Tx?

A

Prompt diagnosis

Laminectomy performed before 8 hours – cord ischemis is reversible before then

(Large jury awards are associated w/ this)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does Res Ipsa Loquitor mean? What is it used for?

A

Let the things speaks for itself

Lawyers use this term to argue when evidence can clearly prove harm to a pt

Ex) Using expired materials; using non-FDA meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is arachnoiditis? What is it associated with? (3)

A

Extensive sclerosis of arachnoid membranes & constriction of vascular supply

  1. Nonapproved-FDA drugs in IT or epidural space
  2. Betadine contamination
  3. using non-preservative free solutions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

We should always prepare ______ with neuraxial procedures. Why? (6)

A

GA

-Failed block
-High spinal
-LAST
-Anaphylaxis
-Severe CV collapse
-Case exceeds duration of LA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T/F: Betadine is included in neuraxial kits & is used for best practice

A

F

Although in kits – not best practice
Alcohol & Chlorahexidine combo is best practice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

There are ______ items in a spinal kit than epidural

A

less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is in a spinal kit?

A
  1. 3.5 inch stylet
  2. Introducer
  3. LA
    - 1% lidocaine 5ml glass vial
    - SAB 2ml glass vial (note: med/baricity)
  4. Prep
  5. Sterile drapes
  6. Needles (22g or smaller & 18g)
  7. Filter needle
  8. Sterile gloves, hats, masks (x2 for you & pt)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

With a _____g needle you dont need an introducer with SAB. Why?

A

22g

Sturdy & thick enough to pierce the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T/F: The regular spinal needle can puncture the skin

A

F

very weak & cannot pierce skin UNLESS using a 22g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hub up =

A

bevel up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

You need an ________ to pierce the skin for a spinal. Describe it

A

introducer

strong & sturdy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the purpose of the stylet in a spinal needle?
Stays inside needle to help prevent clotting off from tissue & blood-- when you pull it out, should see CSF
26
What are the cutting spinal needles? (2)
Quincke (25g) Pitkin
27
What are the non-cutting/pencil-point spinal needles? (5)
1. Sprotte (25g) 2. Whitacre (25g) 3. Pencan 4. Greene (This is NOT a pencil-point needle) 5. Gertie Marx (26g)
28
What are the 2 things we need to check before using a spinal/epidural kit?
1. Lot # 2. Expiration date
29
What are the advantages of using spinal pencil-point needles? (3)
1. Drag fewer contaminants 2. "Click/pop" sensed <---- hallmark 3. less risk of PDPH
30
What are the steps for a SAB? (20)
1. Timeout 2. Monitors 3. Positioning - curl back 4. Mark L4-L5 5. Prep w/ 3 sponges 6. Drape 7. Meds w/ filter needle 8. Wipe off excess betadine 9. Localize 1% lidocaine **10. Introducer** **11. Insert spinal needle** **12. Click/Pop when dura transvered** **13. Withdraw stylet & CSF will flow** 14. No CSF? --> Rotate needle 360 degrees **15. Aspirate CSF w/ syringe w/ LA -- if hyperbaric = swirl** **16. Inject SAB LA** 17. Lay pt flat 18 . BP/HR eval 19. Dermatome assessment 20. Reposition to prevent high spinal (1st 5 mins)
31
What are common problems with SAB? (7)
1. No swirl (only w/ hyperbaric) 2. resistance w/ injection (incorrect spot) 3. Lack of free flow CSF when spinning 360 4. Parasthesia 5. Blood instead of CSF (a pinch of blood is normal) 6. No block (check to see if its expired) 7. Partial block (reposition pt or switch to GA)
32
What is in the epidural kit that isnt in the spinal? (9)
1. Test dose: 1.5% lidocaine w/ 1:200,000 epi (5ml) 2. Tuohy needle (17/18g) 3. 20 ml syringe 4. Line filter 5. LOR syringe 6. Epidural catheter 7. Catheter cap 8. Catheter securer tap (x2) 9. Sterile saline
33
What are the epidural needles? Describe them (4)
1. Tuohy -Most curved (30 degrees) -less likely to puncture SA space 2. Hustead -15 degree curve 3. Crawford -Preferred w/ difficult catheter placement or steep angle -0 curve 4. Weiss -15 degree curve -has wings
34
Which epidural needle has wings?
Weiss W = wings
35
Which epidural needle has no curvature?
Crawford C = curve 0
36
Which epidural needle is least like to puncture the SA space?
Tuohy
37
T/F: All epidural needles are blunt tip
T Note: Crawford needle has a more pointed tip than the others -- not strictly blunt
38
Where do put the bevel for an epidural needle?
Wherever we want the catheter to go... Normally up
39
What gauge is a tuohy needle? What are the markings that we need to know?
17/18g or even 19g each segment = 1cm end of needle/hub = 9cm middle of window = 10cm
40
What are the pros & cons of multipore/multi-orifice epidural catheter?
Pro: Better distribution of LA Cons: Higher risk of inadvertent IV placement
41
The optimal epidural space length of the catheter is ________
3-5 cms (This is the amount of catheter you want in the epidural space)
42
_____ tip catheters reduces inadvertent SAB placement w/ epidurals
softer
43
Describe the Arrow FlexTip Plus epidural catherter
-easier to thread -stiffer --> inadvertent SAB puncture possible -less expensive
44
What do the lines mean on the epidural catheter?
1st line: 5cm 2nd set of lines (2 lines): 10cm bolded line after 10cm: 11cm 3rd set of lines (3 lines): 15cm 4th set of lines (4 lines): 20cm **Use the last line**
45
How do you determine the distance for your epidural catheter?
After reaching the epidural space with the tuohy needle 1. Count how many cm outside of needle --> determine how many cm inside (needle from hub = 9cm) 2. Take the amount thats inside from tuohy needle + 3-5cm That is the total amount of catheter that needs to be inside the pt
46
What is the protocol for neuraxial & tattoos? (2) why?
1. Tattoo needs to be over 5 months old 2. Insert needle in an area where there is less/no ink Tattoo ink could be carried into the spine --> **Chemical Arachoiditis**
47
What is the procedure for an epidural placement?
1. Same as SAB 2. Point Tuohy needle up **3. Place needle in interspinoud ligament & withdraw stylet (should be stable)** **4. Attach LOR syringe (Saline/air/both)** **5. Continue advancing needle into LOR (note depth)** **6. Threaded catheter** **7. Advanced catheter 3–5cm into epidural space** **8. Withdrawn needle while advancing catheter** **9. Make sure catheter is at correct skin marking** **10. Test dose catheter w/ 1.5% lidocaine w/ epi (3cc)** 11. Secure dressing 12. Establish segmental blockade w/ epidural dosing
48
What is the composition of the test dose in epidurals? Purpose? What would we see?
Composition = 1.5% lidocaine w/ epi 1:200,000 (3cc) Lidocaine: make sure you're not in the SA space -Dense motor block within 5 mins (REMEMBER epidural is slower than spinal) Epi: make sure you're not in the epidural vein -Increase in HR by 20% -ringing in ears (tinnitus) -metallic taste -numbness around mouth
49
What #'s do we need to record w/ epidurals? (3)
1. Depth to epidural space 2. Catheter marking at skin 3. Catheter length in the epidural space
50
What are the 2 ways you can identify if you're in the epidural space?
1. LOR 2. Hanging drop method
51
What are special considerations we should have with epidural test dose w/ pregnant women?
Give test dose after contraction for clearer (nonskewed) results
52
What are special considerations we should have with epidural test dose w/ pts on heart meds?
A big increase in BP (>20mmHg) = need in vein
53
What is the 1st sign that the epidural catheter is in the vein w/ test dose?
Numbness of tongue
54
Recommended Top Up time: lidocaine
60 mins
55
Recommended Top Up time: 2-chloroprocaine
45 mins
56
Recommended Top Up time: Mepivacaine
60 mins
57
Recommended Top Up time: bupivacaine & ropivacaine
120 mins
58
T/F: it is best practice to top off using recommended time with epidurals
F Best practice is 2 sensory dermatome levels
59
What are common problems encountered w/ epidurals? (6)
1. wet tap 2. Paresthesia 3. Can't threat catheter (need to open epidural space more with more air/saline up to 10cc) 4. Aspirate blood 5. Positive test dose 6. False positive test dose
60
A good epidural test dose is _______
negative
61
What creates a false positive test dose?
-giving a test dose DURING a contraction -asking questions that make them answer in a certain way about the symptoms
62
With CSE, which procedure is first?
Spinal ---- then epidural
63
Briefly describe a CSE procedure
1. Use Touhy needle as guide to epidural space -LOR 2. Put spinal needle through Touhy needle -go to SA space 3. Inject spinal LA 4. Pull spinal needle out 5. Thread epidural catheter epidural space 6. Begin segmental block w/ epidural dosing

Principals Summer 2025 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions