Regional

Question 1

Highest point of iliac crests?

Answer 1

L4

Question 2

Level of umbilicus

Answer 2

T10

Question 3

level of posterior iliac spines?

Answer 3

S2

Question 4

Inferior edge of scapula?

Answer 4

T7

Question 5

First palpable spinous process

Answer 5

C2

Question 6

Cord ends at what level in adult? Subarachnoid space?

Answer 6

Cord - L2, Subarachnoid space - S2

Question 7

Most common site for spinal anesthesia?

Answer 7

L3-L4

Question 8

What causes the physiological response of spinal anesthetic?

Answer 8

preganglionic sympathetic blockade

Question 9

Spread of local (spinal)?

Answer 9

specific gravity & position, as well as dose, site of injection, etc

Question 10

PDPH incidence?

Answer 10

2%, headache is postural with relief in the supine position

Question 11

PDPH treatment?

Answer 11

conservative - hydration, caffeine, analgesics, abdominal binder, sumatriptan (imatrex)

Question 12

Epidural level determined by what?

How to estimate?

Have T 12- but want T10? How much to give?

Answer 12

VOLUME!!

T12 to T10… 3-4 ccs

Question 13

Hyperbaric solutions typically contain what?

• Tetracaine, bupivacaine, lidocaine, procaine

Answer 13

Dextrose

Question 14

Isobaric solutions typically contain what?

-tetracaine, bupivicaine, lidocaine

Answer 14

saline

Question 15

Hypobaric solutions typically contain what?

-tetracaine, bupivacaine

Answer 15

water (h2o)

Question 16

Epidural placement midline approach?

Answer 16

Skin-SQ-supra-inter-liga flavum- epidural space!

Question 17

Epidural paramedian approach

Answer 17

skin-SQ-liga flavum - epidural space!

Question 18

TAP block’s hit what?

Advantages?

Disadvantages?

Answer 18

plane between the transversus abdominis and internal oblique muscles!

intercostal nerves T7-T12 - hits iliohypogastric nerves through here

Advantages: no hemodynamic changes, no motor blockade of LE.

Disadvantages: no analgesia of visceral peritoneum or abd contents. (is an adjunct to pain management, not primary.

Question 19

IS block where?

covers what area?

Answer 19

between Anterior and middle scalene muscles
C5-C7
(spares some of C8-T1, which is why this works for shoulder, not hand.)

Question 20

What is stellate ganglion?

indications?

Complications?

Answer 20

most easily felt at C6

indications: regional circulatory insufficiency, complex regional pain syndrome.
complications: hematoma, intravascular injection, dural puncture, pleural puncture.

Question 21

Axillary block.. what is missed?

Answer 21

Musculocutaneous

Question 22

Assessment of UE blockade?

Answer 22

4 P's
Push = radial
Pull = musculocutaneous
pinch index = median
pinch pinky = ulnar

Question 23

Bier block
How long does it last?
Tourniquet up for how long? Why?

Answer 23

Can last 45-60 minutes (use dilute lidocaine - 0.5%)

15-20 mins minimum, allows time for tissues to bind with local, limit systemic effects upon deflation.

Question 24

what nerves do wrist blocks hit?

Answer 24

radial, median, and ulnar

Question 25

if you can palpate the ulnar artery you can palpate the ?? nerve?

Answer 25

ulnar

Question 26

FNB Remember what acronym?

Answer 26

``` NAVEL: Nerve Artery Vein Empty space Lacunar ligament ```

Question 27

Above knee?

Answer 27

Femoral nerve

Question 28

Below the knee

Answer 28

Sciatic | + Saphenous (only FN present this far down) - most medial of FNB

Question 29

Largest nerve in the body?

Answer 29

Largest nerve trunk is the Sciatic nerve

Question 30

Popliteal block

Answer 30

part of Sciatic nerve cephalad 7-10 cm (hot spot!) Where do you put needle? NOT IN POPLITEAL FOSSA!!!! move it up 7 to 10 cm up the leg above pop crease.

Question 31

ankle block .. what are nerves?

Answer 31

deep peroneal, superficial peroneal, posterior tibial, sural, and saphenous.

Question 32

Horner's Syndrome?

Answer 32

Blocks sympathetic stimulation to the face! * a guarentee of block of arm" ``` Droopy eyelid - ptosis DROOPY!! P = Ptosis pupil constriction - myosis facial anhydrosis (no sweat) ```

Question 33

What is the substantia gelatinosa?

Answer 33

Lamina of Rexed II (in the dorsal horn of gray matter)

Question 34

Branches of Facial Nerve? (5)

Answer 34

Mandibular, Zygomatic, Temporal, Buccal, and cervical! | To Zanzibar by motor car

Question 35

Cervical Plexus block? Where is it, why? Common problems?

Answer 35

Level of T12ish, (pt. in prone position) common for tx of abdominal visceral cancer type pains, pancreatic. Common problems are inadvertant AORTA puncture,

Question 36

CRPS Type I pain block in RUE assessed how?

Answer 36

Although Horners syndrome is common sign, this indicates SNS of the face, not necessarily the extremity itself. Look for temperature change in R limb.

Question 37

SLN? What is its function? How is it blocked?

Answer 37

The superior laryngeal nerve is comprised of two branches: the external branch which provides motor innervation to the cricothyroid muscle, and the internal branch which provides sensory innervation to the laryngeal mucosa above the level of the vocal cords. SLN block is performed between the lateral aspect of the hyoid bone and the thyroid cartilage at the thyrohyoid membrane.