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Regional > Regional Upper extrmities!!! (Josh's perspective) > Flashcards

Regional Upper extrmities!!! (Josh's perspective) Flashcards

Time to get up lift your arms up!!!! stare them down with your biggest and scariest mean mug, and say fuck you upper extremities I got this shit I own you fuck nutz, you want a challenge I accept game on bitch.... I just did this and it felt good!!! true story!!!!

1
Q

Goals of anesthesia

A
  1. prefered by some pt’s
  2. Just as fast
  3. Avoid GA
  4. preemptive
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2
Q

How many cervical nerves do you have

A

8

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3
Q

hpw many cervical vertebrae do you have?

A

7

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4
Q

What nerves are your vertebra for brachial plexus?

A

C5-T1 (+/- C4 & T2)

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5
Q

Mnumonic for brachial plexus

A

Really

Tough

Dogs

Can

Bite

( i know very disapointing i have nothng better)

( i was thinking Redhead Trucker Dikes Can Blow)

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6
Q

Brachial plexus Anatomy and Block locations:

Interscalene

A

roots

trunks

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7
Q

Brachial plexus Anatomy and Block locations:

supraclavicular

A

trunks

and

divisions

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8
Q

Brachial plexus Anatomy and Block locations:

Infraclavicular

A

cords

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9
Q

Brachial plexus Anatomy and Block locations:

axillary

A

terminal branches

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10
Q

Brachial plexus Anatomy and Block locations: ways to remember

startig at the highest and work down UE with both brachial plexus nerve and and locations

A

Interscalene-roots/trunks

Supraclavicular- truncks/divisions

Infraclavicular- cords

Axillary- terminal branches

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11
Q

lable this

A
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12
Q

When doing a scalene block you have about a ____% chance of blocking the phrenic nerve?

A

100%

(gottcha)

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13
Q

*********************

lable the nerves that inervate this SUPINATED arm

A
  1. Median n
  2. Radial n (superficial br.)
  3. Musculocutaneous n. (lateral antebrachial cutaneous n.)
  4. Radial n. (inferior lateral brachial cutaneous n.)
  5. Axillary n.
  6. supraclavicular n. (cervical plexus)
  7. ulnar n. (palmar digital br.)
  8. Ulnar n. (palmar br)
  9. Median antebrachial cutaneous n.
  10. Intercostalbrachial and nedial brachial cutaneous n.
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14
Q

lable the cerviacal nerve in supination position

A
  1. C7
  2. C6
  3. C5
  4. T1
  5. C8
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15
Q

*************

label this!! Know what part of hand/arm is controlled by which nerve!!

A
  1. Median n.
  2. Ulnar n.
  3. Median antebrachial cutaneous n.
  4. Radial n.
  5. (posterior antebrachial cutaneous n.)
  6. Pasterior brachial cutenuous n.)
  7. (inferior lateral brachial cutaneous n.)
  8. Axillary n.
  9. Supraclavicular n. (cervical plexus)
  10. Intercostabrachial cutaneous n.
  11. Musculocutaneous n. (lateral antebrachial cutaneous n.)
  12. Radial n.
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16
Q

Lable the cervical nerves in UE during pronation

A
  1. C8
  2. C7
  3. C6
  4. C5
  5. T1
  6. C8
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17
Q

INTERSCALENE: PEARLS

for sx of of what?

A

ahoulder and upper arm

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18
Q

INTERSCALENE: PEARLS

the block often spares distribution of what nerve?

A

ulnar

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19
Q

INTERSCALENE: PEARLS

needle insertion site?

A

B/t anterior and middle scalene muscles at C6 line

Directed slightly posterior and caudad (toward ass)

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20
Q

INTERSCALENE: PEARLS

stimulates what nerves?

A

musculacutaneous

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21
Q

INTERSCALENE: PEARLS

you should go no deeper than what?

A

1.5 cm

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22
Q

INTERSCALENE: PEARLS

the block is contraindicated in what disease process? and why?

A

COPD

b/c of phrenic nerve block

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23
Q

INTERSCALENE: PEARLS

what are you most worried about during this block and why?

A

speed and depth of injection

b/c closeness tp spine

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24
Q

INTERSCALENE: PEARLS

you give a SLOW injection of how much?

A

30-40 ml

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25
INTERSCALENE: PEARLS what type of spread are you dont want to be getting when doing the block?
epidural spread
26
INTERSCALENE: PEARLS lable the parts
1. Middle scalene muscle 2. Anterior scalene muscle 3. Brachial plexus 4. Cricord cartilage 5. Lateral edge of sternocleidomastoid muscle 6. 1st rib 7. 2nd rib
27
INTERSCALENE: PEARLS you want to palpate the scalene froove with pt supine and head \_\_\_degrees to contralateral side
30
28
INTERSCALENE: PEARLS what type of needle is good? and how is it advanced
25g 1.5 inch B-bevel almost perpindicular to skin advance medial and caudal till paresthesia or evoked contraction
29
INTERSCALENE: PEARLS what is a pot complication
Horner's syndrome (combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis), sometimes accompanied by decreased sweating (anhidrosis) of the face on the same side) redness of the conjunctiva of the eye is often also present. Apparent enophthalmos is also a frequent symptom
30
INTERSCALENE: PEARLS Ill geive a response and then state the area involed and the problem! 1. Phrenic 2. Scapula 3. Pectoralis 4. Biceps 5. Hand
1. diaphram- too anterior 2. thoracodorsal- too posterior 3. anterior thoracis-???? 4. muscolocutaneous--good 5. Distal branches-- good
31
INTERSCALENE: PEARLS complications ? (4)
epidural spread IV injection (vertebral artery) Phrenic block Horner's syndrome
32
SUPRACLAVICULAR: Advantage?
most complete coverage for arm surgery
33
SUPRACLAVICULAR: position of pt?
Supine with head 30 degrees to contralateral side
34
SUPRACLAVICULAR: needle insertion tech?
insertion os SCM at the clavicale is noted move 1 inch lateral insert needle 1 fingerbreath superior and direct needle caudad
35
SUPRACLAVICULAR: how local is used?
25-40 ml
36
SUPRACLAVICULAR: has the highest incidence of what complication?
pneumothorax
37
SUPRACLAVICULAR: beside pnumo what is another complication ?
Horner's syndrome
38
SUPRACLAVICULAR: is catheter placement advisable? why or whynot?
no due to mobility of the neck
39
SUPRACLAVICULAR: label
1. Middle Scalene muscle 2. brachial plexus 3. Subclaviian artery 4. anterior scalene muscle 5. sternocleidomastoid muscle 6. subclavian 7. 1st rib 8. 2nd rib
40
SUPRACLAVICULAR: just pictures for a good view point
41
INFRACLAVICULAR: PEARLS what is the insertion site and tech?
2cm medial /2 cm caudad from coracoid processs(with arm at side) insert perpendicular coracoid process-a small hook-like structure on the lateral edge of the superior anterior portion of the scapula. Pointing laterally forward, it, together with the acromion, serves to stabilize the shoulder joint. It is palpable in the deltopectoral groove between the deltoid and pectoralis major muscles
42
INFRACLAVICULAR: PEARLS is for nerve stimulation were?
3rd and 4th fingers Median nerve
43
INFRACLAVICULAR: PEARLS the block is usually blocking what part of the brachial plexus?
cords
44
INFRACLAVICULAR: PEARLS what else is the blocked good for besides the median n.
reliable for tourniquet pain-intercostobrachial reliable blocked axillary nerve think arm
45
INFRACLAVICULAR: PEARLS is better for placement of what?
a catheter
46
INFRACLAVICULAR: PEARLS a pic for reference
47
INFRACLAVICULAR: PEARLS i'll say the location and then state what the response indicates 1. Pectoralis- 2. Deltoid 3. Biceps 4. median
1. too shallow 2. axillary (unreliable) 3. musculocutaneous (unreliable) 4. median -good
48
INFRACLAVICULAR: PEARLS complications
hematoma- b/c non compressible site Pneumothorax -0.0-0.7%
49
AXILLARY BLOCK: PEARLS block what part of arm
below elbow
50
AXILLARY BLOCK: PEARLS is it good for tourniquet coverage?
questionable
51
AXILLARY BLOCK: PEARLS 2 different approaches
transarterial stimulator
52
AXILLARY BLOCK: PEARLS with the block the musculocutaneous n. is hidden in the what?
coracobrachialis
53
AXILLARY BLOCK: PEARLS mneumonic to remember?
MMUR M&Ms Under the Rug (i just dont know what the fuck it stands for)
54
Ahhhhh i got it!!! what does MMUR stand for?? or M&Ms Under the Rug?
when doinf the axillary block the nerves are in decreasing order musculocutaneous nerve median nerve Ulnar nerve radial nerve
55
AXILLARY BLOCK: PEARLS pic for references
56
AXILLARY BLOCK: PEARLS complications (2)
IV injection neural injury
57
BIER BLOCK: fun fact- first used by whom?
august ier in 1908
58
BIER BLOCK: how to perform?
Small IV in operative hand Exsanguate with esmarch bandage tourniquet up to 50 mmhg \>SBP 40-50 mL's 0.5% lidocaine
59
BIER BLOCK: can last how long?
1.5 -2 hours
60
BIER BLOCK: dont deflate until what?
\< 30 min
61
Gross anatomy of brachial plexus label
1. roots 2. 3 trunks 3. divisions (3 ventral 3 Dorsal) 4. (3) cords 5. (terminal) branches Really Tough Dogs Can Bite Randy Travis Drinks Cold Beer
62
so how to rememeber the brachial plexus Randy Travis Drinks Cold Beer
63
Brachial Plexus Anatomy and Block Loacation Interscalene- Supraclavicular- Infraclavicular- Axillary-
Interscalene- roots/trunk Supraclavicular- trunk/divisions Infraclavicular- cords Axillary- terminal branches
64
INTERSCALENE: SONOANATOMY used to visualize what?
ROOTS of the brachial plexus
65
INTERSCALENE: SONOANATOMY look or appear how on the US
round oval hypo echoic structures
66
INTERSCALENE: SONOANATOMY the roots of the plexus lies where?
b/t the anterior and middle scalene muscle
67
INTERSCALENE: SONOANATOMY pic to see all
68
INTERSCALENE: SONOANATOMY again another pic
69
INTERSCALENE: SONOANATOMY yet another pic
70
SUPRACLAVICULAR: US truncks and divisions 3 trunks 6 divisions just a good pic for you
71
INFRACLAVICULAR: US What level of brachial plexus are we looking at?
the cords
72
INFRACLAVICULAR: US 1. the cords are arranged around what? 2. the lateral and medial cords are superficial to or at the level of what? 3. The posterior cord is \_\_\_- to the artery?
1. axillary artery 2. subclavian artery 3. inferior
73
INFRACLAVICULAR: US picture to look at
74
INFRACLAVICULAR: US what do you see
75
AXILLARY US: just start with a picture to show you where u are
76
AXILLARY US: another pic
77
DISTAL BLOCKS: advantages (2)
* can block the nerve nearly anywhere you can see it on US * Good rescue (esp if you used a long acting LA for a case that starts in 10 min
78
US PEARLS: Use adequate amount of what?
gel
79
US PEARLS: ergonomics?
position supplies so as to keep eyes on screen and needle
80
US PEARLS: use appropriate _______ for target tissue?
Frequency
81
US PEARLS: adjust the _____ as appropriate?
Gain
82
US PEARLS: \_\_\_\_\_\_\_ changes in pressure or orientation = _____ changes in image quality
Subtle dramatic
83
US PEARLS: focus on known ________ if you get lost start scanning from known structures
Landmarks
84
US PEARLS: follow target from ______ to \_\_\_\_\_\_
proximal to distal
85
US PEARLS: biggest pitfalls
Oblique view of needle moving needle instead of probe for better view Looking only at the US screen Left/right probe orientation

Regional (24 decks)

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