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Regional Flashcards

(103 cards)

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1
Q

most lipohilic opioid

A

sufentanil

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2
Q

most hydrophilic opiod

A

morphine

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3
Q

hydrophilic opoids have increased risk of what in neuraxial?

A

NV
pruritis

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4
Q

where does conus medularis end?

A

L1

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5
Q

where does dural sac end in adults and peds? what level approximates this in adults?

A

S2 adults post. sup. iliac spine
S3 peds

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6
Q

which nerve fibers are unmyelinated

A

c fibers

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7
Q

describe differential spinal block levels

A

sensory is 2 above motor
ANS is 2-6 above sensory

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8
Q

describe differential block levels in epidurals

A

sensory and ANS 2-4 levels above motor

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9
Q

3% chloroprociane dose for spinal

A

30-40mg

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10
Q

4 main side effects from neuraxial opioids

A

pruritis (most common)
resp depression
urinary retention
N/V

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11
Q

urinary retention from neuraxial opiods is most common in what population

A

young males

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12
Q

what can reactive herpes simplex labialis in OB and post partum patients?

A

epidural morphine

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13
Q

cutting nedles

A

quincke
pitkin

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14
Q

non cutting needles

A

sprottle
whitacre

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15
Q

s/s PDPH

A

fronto-occipital headache
N/V
photophobia
diplopia
tinnitus

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16
Q

most common cause of post spinal bacterial menengitis

A

streptococcus viridans

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17
Q

most effective antiseptic when cleaning the back

A

alcohol + cholorohexadine

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18
Q

what causes transient neurologic symptoms

A

exposure to high concentrations of LA

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19
Q

TNS treatment

A

NSAIDS
opioids
trigger point injections

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20
Q

TNS typically lasts how long?

A

1-7 days

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21
Q

most common offending LA causing TNS

A

lidocaine

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22
Q

what increases risk of cauda equina syndrome

A

spinal microcatheters

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23
Q

cauda equina syndrome s/s

A

bowel and bladder dysfunction
sensory deficits
weakness
paralysis

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24
Q

TNS s/s

A

severe back and butt pain radiating to both legs

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25
when do you take out broken epidural catheter left in back?
only of symptomatic
26
when is it okay to give second spinal dose?
only if first one didn't set up at all after 15-20min
27
intrathecal LA site of action
act on pre-ganglionic fibers in spinal nerve roots
28
primary site of neuraxial opiods
substania gelatinosa
29
epidural needle angles
crawford 0 huestead 15 tuohy 30
30
Brachiel plexus originates from what?
ventral roots of C5-T1. sometimes C4 and T2 contribute as well.
31
draw brachial plexus and label cords
32
supraclavicular non-terminal branches of BP
dorsal scapular suprascapular long thoracic
33
infraclavicular non terminal branches of BP
lateral pectoral n medial pectoral n
34
from where does suprasclavicular nerve arrise?
cervical plexus
35
trick to asesss BP block
Push 'eR Radial nerve Pull 'eM Musculocutaneous Pinch Me Median Pinch U Ulnar
36
what artery is most easily injected during an interscalene block
vertebral artery
37
can you get horners syndrome from supraclavicular block?
yes
38
positions of cords during infraclavicular block
medial 3 post 6 lateral 9
39
highest risk of pneumothorax is with what block?
infraclavicular
40
what blocks has a risk of injection into distal subclavian artery or vein?
infraclavicular
41
when is bier block not a good option
if they will have any post op pain
42
how early can tourniquet pain begin?
as early as 25min
43
individual radial nerve is blocked where?
between biceps tendon and brachioradialis
44
waht contributes to lumbar plexus
L1-L4 T12 in 50% of population
45
nerves in lumbar plexus
Ikes Iguanna Gets Laid on Fridays iliohypgastric ilioinguinal genitofemoral lateral fem cutaneous obturator femoral
46
sacral plexus originates from where?
S1-S4
47
nerves in sacral plexus
SIPPS sup gluteal n inf fluteal n post cutaneous n pudendal n sciatic n
48
foot and ankle innnervated by what nerves?
saphenous sural superficial peroneal deep peroneal tibial
49
what nerve control hip flexion
femoral nerve
50
what nerve controls hip extension
sciatic
51
what nerve control knee extension
femoral
52
what nerve controls knee flexion
sciatic n
53
what nerve controls ankle flexion
tibial n
54
what nerve controls ankle inversion
deep peroneal
55
what nerve controls ankle dorsiflexion
peroneal n
56
what nerve controls ankle eversoin
superficial peroneal n
57
PENG block indicated for
hip fx or arthroplasty
58
risk wiht peng block
risk of ureter injection
59
fascia iliaca block indications
femur and or knee procedures acute pain from hip fractures
60
fascia iliaca blocks what nerves?
femoral n obturator n lat fem cutaneous n
61
where do you actually inject for fascai iliaca block?
below the fascia iliaca
62
draw the foot with foot and ankle nerves
63
all nerves in ankle are next to vascular structures except for what?
superficial peroneal nerve
64
best way to assess adequecy of femoral n block?
knee extension
65
what block is best for total hip?
PENG
66
what block is best for ORIF of femur
fascia iliaca
67
serratus ant plane block targets what?
axilla
68
PECS 2 blocks includes what
PEC1 block as well
69
do you get motor or sensory block with an intercostal block?
both motor and sensory
70
can you get bilateral block with PVB?
yes with large volume
71
what does PVB target?
spinal nerves exitign vertebral foramen
72
ESB target?
dorsal and ventral rami of thoracolumbar nerves
73
rectus sheat block targets?
thoracolumbar nerves and ant cutaneous branch
74
TAP block targets?
thoracolumbar nerves T6-T11
75
subcostal tap block blocks block what area?
area above umbilicus
76
lateral and post TAP blocks get what area?
area below umbilicus
77
what block for herpes zoster?
intercostal block
78
where to do perform each QL block in relation to QL muscle
QL1 lateral to QLM QL2 post QLM QL3 Ant QLM
79
what are the largest spinal nerves?
L5 and S1
80
epidural placement level for radical prostatectomy and total hip
T8 radical protstatectomy L2 total hip
81
most common SE of epidural blood patch
backache
82
S/S of epidural hematoma
bladder dynfunction radicular pain LE weakness
83
caudal okay for what level and below
T10
84
musculocutaneous neerve covers what part of the arm
anterolateral forearm
85
block with the highest risk of chylothorax
infraclavicular
86
which side has a higher risk of pneumothorax?
right side
87
what kind of patinets are at higher risk of pneumothorax from a block?
tall and thin
88
which block has a risk of median nerve injury
axillary block
89
many, if not most, UE nerve injuries are from what?
unkown cause not positioning injuyr
90
other landmark that can be used for sup laryngeal nerve block in obese patients
sup nothc of thyroid
91
what gets blocked in paraverterbral space
sympathetic trunk and mixed spinal nerve
92
what nerve innervates oricularis occuli muscle
facial nerve
93
risk of arterial injection into what vessel with deep cervical plexus block
vertebral artery
94
SAB block hemodynamic effects
^ CO from the massive decrease in SVR HR effects are variable
95
what to use for test dose wiht PNB using nerstim
5% dextrose in water no LA or NS
96
drugs that increase IOP
sux neostigmine atropine
97
vertebral canal is the smallest in what region
thoracic region
98
N/V from spinal is from waht
unoppsed vagal stimulation and intrathecal opiods
99
epidural not good for what kind of surgery
ankle
100
Twhat is line with bottom of scapula
T7
101
most distinguishing factor of PN under ultrasound
honeycomb apperance
102
epidural hematoma s/s
severe back pain, radicuolpathy, prolonged blockade, bew bladder or bowel dysfunction
103
epidural hematoma requires surgical decompression how soon?
within 8-12hours

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