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Principles II-Exam III-Brachial Plexus 7-15
This will only hurt for a second...
35
Nursing
Graduate
11/21/2009

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Cards

Term

 

 

The ventral division of the upper limb generally supplies the _____ portion of the upper extremity.

The dorsal portion generally supplies the ________ portion of the upper extremity.

Definition

 

Ventral division supplies the FLEXOR portion

 

Dorsal portion supplies the EXTENSOR portion

Term

 

 

Where does the phrenic nerve pass? Between what? Over/under what?

Definition

 

 

Between the anterior and middle scalenes and OVER the surface of the anterior scalene muscle.

Term

 

 

It see a diaphragmatic twitch with your nerve stimulator during an interscalene brachial plexus block. Whats the deal?

Definition

 

 

Your needle placement is ANTERIOR to the plexus.

Term

 

 

You see a stimulating twitch in the trapezius during an interscalene brachial plexus block. Whats the dealio?

Definition

 

 

Your needle placement is POSTERIOR to the plexus.

You are in contact with the spinal accessory nerve (CN XI) which runs posterior to the brachial plexus over the surface of the middle & posterior scalenes.

Term

 

 

The cords of the brachial plexus are named according to what?

Definition

 

 

Their anatomical position in relation to the axillary artery.

Term

 

 

This nerve feeds motor to the muscles of the upper arm.

Definition

 

 

Musculocutaneous nerve

Term

 

 

This nerve feeds motor to muscles of shoulder.

Definition

 

 

Axillary nerve

Term

 

 

These nerves feed motor to the muscles of the lower arm and hand.

Definition

 

 

Radial nerve

&

Ulnar nerve

Term

 

 

The nerve feeds muscles of the hand.

Definition

 

 

Median nerve

Term

 

 

 

Definition
Term

 

 

Where is the location of injury for Klumpke's palsy?

Definition

 

 

Roots C8 & T1

Term

 

 

Where is the location of injury for Erb's palsy?

Definition

 

 

Roots C5 & C6

Term

 

 

This approach is great for reduction of a shoulder dislocation.

Definition

 

 

Interscalene approach

Term

 

 

This block is NOT for lower arm surgery. But why?

Definition

 

 

Interscalene approach

because it spares the ULNAR nerve

Term

 

 

A key point for the interscalene approach is that it can be done in this position.

Definition

 

 

Its a trick: It can be done in ANY position!

Term

 

 

Why is the interscalene approach undesirable for patients w/ respiratory function that is impaired?

Definition

 

 

Because the phrenic nerve is sometimes involved.

Term

 

 

Your patient has COPD. Can you use an interscalene block? Why/why not?

Definition

 NO NO NO!! An interscalene block is VERY dangerous for end stage COPDers because tehy need the diaphragm to move in order to breathe.

 

Because this is a volume block, its possible that the phrenic nerve may be involved.

Term

 

 

Typically, where is the site of intravascular injection with an interscalene block?

Definition

 

 

The VERTEBRAL ARTERY, because of its location to the middle scalene.

Term

 

 

Name the (6) symptoms of Horners syndrome

Definition

-IPSILATERAL

-Miosis

Ptosis

Anibrosis

Nasal stuffines

Hoarseness (recurrent laryngeal)

Term

 

 

What would you see if you had recurrent laryngeal nerve involvement/block?

Definition

 

 

Ipsilateral floppy cord

You should do a DVL to check the cords.

Term

 

 

 

What produces the sympathetic blockade and produce Horner's symptoms?

Definition

 

 

The injection of local around the area of the stellate ganglia

Term

 

 

What is the position for an interscalene approach?

Definition

-Supine position

-Lower the shoulder on the side of the block

-Turn head away

-Palpate the cricoid cartilage ring

 

Term

 

 

You're doing an interscalene block. You've located the cricoid cartilage ring (C-6) and have drawn a line posteriorly over the lateral border of the SCM. But you still can't feel the SCM, what do you do?

Definition

 

Have the patient raise their head against gentle resistance then relax. Behind the SCM lies the anterior and middle scalene muscles. There is a small groove & this is the level where the trunks of the brachial plexus lie.

Term

 

 

You've located your brachial plexus "groove" for your interscalene block. Your ready to put in your needle, now what do you do?

Definition

-Prep the skin

-A skin wheal is raised at the point of the groove

-A 22 G insulated b-bevel needle usually 1 1/2 inches long is inserted gently perpendicular to the skin & then angled slightly caudad

Term

 

 

Your needle is in for your interscalene block, what do you do w/ your stimulator?

Definition

-Set it at about 1.3 mA

(An illicited muscular response is ideal in the arm-which can also be elicited in the diaphragm or trapezius)

-The mA is decreased gradually to 0.5

-if the needle is placed properly, the twitch response will continue

-hold the needle in place & the person who administers the drug aspirates

-If no blood is seen, inject the local

Term

 

 

When injecting local for an interscalene block, how often should you aspirate?

Definition

 

Every 3-5 cc

Term

 

 

How much local is given in an adult for an interscalene block?

Definition

 

 

30-35 ml of volume

(of 1% Lidocaine or lower percentage)

Term

 

 

What is the most consistent block?

Definition

 

 

Supraclavicular approach

Term

 

 

What aspect of the brachial plexus does a supraclavicular approach effect?

Definition

 

 

The divisions

Term

 

 

What is a concern with supraclavicular approach?

Definition

 

 

Pneumothorax (although it us unusual)

 

-It typically does not appear for several hours (& the patient may already be home)

Term

 

 

What are the landmarks for the supraclavicular approach?

Definition

 

 

Boney prominences

 

(which can be difficult to locate in obese pts)

Term

 

 

Which is the most effective for all portions of the upper extremity?

Definition

 

 

Supraclavicular approach

Term

 

 

You are doing a shoulder surgery w/ a supraclavicular approach, what might you anticipate needing?

Definition

 

 

A cervicle plexus block to block sensation to the skin over the shoulder

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