Week 3- Brachial Plexus And Wrist Flashcards
The phrenic nerve is a major component of __ innervation
Diaphragm
What spinal nerves make up the cervical plexus?
C1-C5
What spinal nerves make up the phrenic nerve? Which one is the major contributor?
C3-C5
Major - C4 - like the plastic explosive “C4” which could blow up your “phriend” the phrenic nerve
What spinal nerves make up the brachial plexus?
C5-T1 (includes “C8”)
5 cats and 1 turkey made a “break” for the opening in the barn door
What block would you do for a carotid endarterectomy?
Cervical plexus
How would you locate the cervical plexus using landmarks?
What is the technique for the block?
Feel the mastoid process behind your ear, then using your thumb width march down the posterior edge of the sternocleidomastoid in stepwise fashion until reaching anterior tubercle of C6 (Chassaignac’s Tubercle)
“Thumb drive”
First aspirate, the inject 4ml per level SUPERFICIALLY
If your patient developed hiccups, what nerve was inadvertently blocked?
Phrenic
What might be some complications of a cervical plexus glock?
Hiccups (phrenic nerve)
Horner’s syndrome
Hoarseness (recurrent laryngeal)
Intrathecal (subarachnoid) or Epidural injection
Sticking a needle a couple times in the side of someone’s neck is no laughing matter- H-H-HIE !!!
What are the symptoms of Horner’s Syndrome?
Ptosis- droopy Miosis- constricted Anhydrosis- no sweat Enophthalmosis- sunken eye Scleral hyperemia- red eye Facial flushing- red face Nasal congestion- stuffed up
If your patient developed hoarseness, what nerve was inadvertently blocked?
What is the mechanism?
Recurrent laryngeal
One of their vocal cords is relaxed
What is Horner’s syndrome indicative of?
Stellate ganglion block, medial to (deeper) brachial and cervical plexus
Why would morbidly obese patients no be ideal candidates for superficial cervical plexus blocks?
Inability to determine depth of infiltration or anatomical landmarks
When you perform an interscalene, you are blocking distal _ and proximal _
Roots
Trunks
“real trojans”
Real Trojans Drink Cold Beer
Roots Trunks Divisions Cords Branches
Dermatomes
tips of fingers and most of palm
Median nerve, nice to “meet” you, when you shake hands your “meetian” nerves touch
Dermatomes
hairy part of hand and forearm including halfway up tricep
Radial nerve, my arm hairs “radiate” from hand to my elbow and start to taper off 1/2way up my tricep.
basically completely opposite of radial art line insertion site
Dermatomes
pinky fingers both top and bottom
Ulnar nerve, when you give a thumbs down to a bad performance you would say that it was “uhhhh”, or have you ever noticed when you take a drink your pinky sticks out and makes a “U” with your face?
Dermatomes
the “arm wrestler” muscle
Musculocutaneous, imagine yourself arm wrestling, you would look right at that “muscle” to will it to pull harder.
Dermatomes
on the ulnar side of the inner forearm, right next to the musculocutaneous
Medial antebrachial cutaneous nerve, it is “medial” to the musculocutaneous and “ante” means before, so “ante” or before the brachial, think of the brachial artery is where you feel infant’s pulse during PALS. Or if you were a poker player maybe you would look at that part of your arm before you place a “middle ante” bet on the cards in your hand.
Dermatomes
above the scapula
Suprascapular nerve, exactly what you would think “supra” or above the scapula on your back
Dermatomes
opposite your armpit
Axillary nerve, which is completely opposite of where I would have thought the axillary nerve was, it is opposite the armpit
Dermatomes
armpit
- high anterior is Intercosto-brachial, it’s “inter” or between your costals (ribs) and your brachial artery
- low armpit is Medial cutaneous, which is where the “meat” smell comes from
Where is Chassaignac’s Tubercle?
C6
What is another name for “roots” that also starts with an “R”?
Rami
