Term
| if patients have neuropathy in the extremity or area for the peripheral block can you proceed? |
|
Definition
| Yes.. but many will not for risks associated with it. |
|
|
Term
| nerves on ultrasound look |
|
Definition
1. round
2. oval
3. triangular |
|
|
Term
| large nerves or plexuses on ultrasound will look |
|
Definition
| dark, or hypoechoic in core and bright or hyperechoic in their perimeter |
|
|
Term
| the hyperechoic layer around nerves that gives it a bright look is made up of? |
|
Definition
| connective tissue surrounding the nerve |
|
|
Term
| Ultra sound frequencies of ___ or higher are needed to distinguish tendons from nerves |
|
Definition
|
|
Term
| The higher or lower the frequency of ultrasound = the poorer the penetration into deeper tissue? |
|
Definition
| Higher frequency = worse penetration |
|
|
Term
| when looking for a nerve by evoking a motor response the needle becomes the black or red wire? |
|
Definition
|
|
Term
| Goal of illiciting a motor response prior to injecting LA is to ensure your are close enough to the nerve but not actually in it. So the perfect mA of current it takes to evoke it should fall tightly within this range |
|
Definition
|
|
Term
| can you use a TOF for motor evoked locating nerves |
|
Definition
| NO. It gives mA that are 10-15 times the necessary voltage!! |
|
|
Term
| The brachial plexus involves what nerves |
|
Definition
|
|
Term
| How many trunks are in the brachial plexus |
|
Definition
|
|
Term
| Where is the brachial plexus best landmarked |
|
Definition
| between the anterior and middle scalene muscles. It passes under the clavicle but over the first rib where it enteres the axilla. |
|
|
Term
| what are the four ways you can block the brachial plexus |
|
Definition
1. interscalene
2. supraclavicular
3. infraclavicular
4. axillary |
|
|
Term
| Which block is going to give you an expected side effect of blockking the ipsilateral phrenic nerve causing hemiparesis of the diaphragm |
|
Definition
|
|
Term
| what are the main trunks of the brachial plexus |
|
Definition
1. Superior
2. Middle
3. Inferior |
|
|
Term
| what are two other smaller risk factors for a interscalene approach to brachial pleuxs block |
|
Definition
1. pneumo
2. recurrent laryngeal nerve block. |
|
|
Term
| What block of the brachial plexus targets its roots |
|
Definition
|
|
Term
| What block of the brachial plexus targets its trunks |
|
Definition
|
|
Term
| what block of the brachial plexus targets its divsions - what is its biggest side effect |
|
Definition
|
|
Term
| What blcok of the brachial plexus targets its cords? What is its biggests side effect |
|
Definition
| infraclavicular - chest discomfort |
|
|
Term
| What block of the brachial plexus targets its braches and whats its draw back |
|
Definition
| Axillary - it may not block the musculocutaneous nerve |
|
|
Term
| If patient starts having convulsions after injection of the local for a interscalene block then you most likely did what |
|
Definition
| injected into the vertebral artery |
|
|
Term
| what two peripheral nerve blocks for brachial blocks are good for the hands, elbow and forearm |
|
Definition
| Axillary and infraclavicular blocks |
|
|
Term
| sensation is dominantly provided to the hand via the ___ nerve. But can also get some sensory from what other nerves |
|
Definition
| Primary sensory from radial nerve, but also some from ulnar and median nerves |
|
|
Term
| what pt comorbidities would make doing a peripheral nerve block a better choice than spinals or epidurals |
|
Definition
1. coagulation issues
2. severe cardiac disease
3. bacteremia |
|
|
Term
| how many nerves provide sensation at or below the ankle to the foot which are |
|
Definition
| 5 nerves which come from the four branches of the sciatic nerve and one branch from the femoral nerve |
|
|
Term
| the major nerve to the sole of the foot is |
|
Definition
|
|
Term
| the lateral side of the foot is innervated by what nerve |
|
Definition
|
|
Term
| the webbing between the first and second toes is innervated by what nerve |
|
Definition
|
|
Term
| how many nerves inervate the foot? Which are deep and which are superficial |
|
Definition
Deep:
1. posterior tibial
2. deep peroneal
Superficial
1. superficial peroneal
2. sural
3. saphenous |
|
|
Term
| max duration of a bier block |
|
Definition
|
|
Term
| for a bier block do you use low concentrations or high concentrations of local |
|
Definition
| Dilute, LOW concentrations and large volumes of LA |
|
|
Term
| what is the cutoff indicator for a bier block? |
|
Definition
|
|
Term
| contraindications to Bier block are related to? |
|
Definition
contraindications for tournaquiet
1. sickle cell disease
2. infection
3. ischemicvascular disease |
|
|
Term
| what type of bandage is used for a Bier block to exanguinate the arm |
|
Definition
|
|
Term
| how high does the tournaquiet need to go above the patients SBP for a bier block |
|
Definition
|
|
Term
| What is the average time a bier block is applied (not max) |
|
Definition
| 45 minutes is the average time people can tolerate the tournaquiet |
|
|
Term
| if pt with a bier block has a double tournaquiet then which side is inflated first? and then which side is inflated after to help with pain |
|
Definition
| Proximal side inflated first. So if pain develops you can inflate the distal and open the proximal. Fresh blood can get to the proximal since nothing occluding it from above. |
|
|
Term
| What nerve may be blocked to help alleviate tournaquiet pain |
|
Definition
|
|
Term
| preservatitive containing solutions for a bier block have been associated with what side effects |
|
Definition
|
|
Term
| What factor determiens the duration of the bier block |
|
Definition
| TIME OF TOURNAQUET BEING UP. As soon as you drop this your circulation washes out all the local and its over. |
|
|
Term
| When its time to deflate the bier block tournaquit you know the chance for a reaction to occur will occur when? |
|
Definition
| in 2-5 minutes after that cuff is dropped is the time for the local to reach its peak level in the serum. |
|
|
Term
| what side effect is often associated with prilocaine |
|
Definition
| methemoglobinemia. Which is not common if this LA is used in a bier block |
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