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35 Cards in this Set
- Front
- Back
Brachial plexus provides majority of the ___& ___ innerv. to the ___ ext.
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sensory & motor innev
to the upper ext. |
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surg proced on the upper ext can be performed by blockade of the _____ at one of seveal sites or terminal branches
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brachial plexus
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Brachial plexus provides ____innervation to the upper ext.
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somatic innerv.
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Brachial plexus formed by the union of the ventral rami of the ____ thru ___ & __ thoracic nerves
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C5-C8 & T1
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Nerve roots leave the intervertebral foramina they converge to form ____
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trunks
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Nerve roots leave the intervertebral foramina they converge to form trunks,then ___
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divisions
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Nerve roots leave the intervertebral foramina they converge to form trunks, divisions, ____
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cords
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Nerve roots leave the intervertebral foramina they converge to form trunks, divisions, cords, ___
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terminal nerves
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Randy Travis Drinks Cold Beers
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Rami, Trunks, Divisions, Cords, Branches
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Terminal Branches
My Aunt Rapes My Uncle |
Musculocutaneous
Axillary Radial Median Ulnar |
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The brachial plexus is enclosed by a ____sheath its origin at the intervertebral foramina to the upper arm
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fascial sheath
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Indications of the Brachial Plexus
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Sole anesthetic surg procedure on upper ext, shoulder, FA, Arm
-Reduction of fractures, dislocations, suturing of tendons, repair of lacs |
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Indications of the Brachial Plexus
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additions to general, post op pain mang.
-dec need of narcs -dec incidence of post anesth NV, atelectasis, hypotension, illeus Chronic pain mang -Reflex Sympathetic dystrophy (RSD) -Frozen shoulder (aid PT) - Brachial plexopathies |
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Contraindications of the Brachial Plexus
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Pt refuse
Coagulopathy Sepsis Pre-exist resp compromise Pt require bilat upper ext blk -second to bilat phrenic nerve blk, total vol of local is toxic |
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Intascalene carries a risk of knocking out the
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diaphragm (phrenic nerve )
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Regional anesthesia choices
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intrascalene brach plex blk
axillary blk Supraclavicular brach plex blk Infraclavicular brach plex blk |
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Techniques: Interscalene blk
Indications |
Perfer tech anest or relax shoulder
Post-op pain rotator cuff rep Palliate acute pain, herpes zoster, brach plx neuritits, shoulder,upper ext trauma & CA pain |
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Techniques: Interscalene blk
Procedure Pt position |
Pt supine, head flt rotated 30-40 deg to opp side
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Techniques: Interscalene blk
Procedure: Palpate |
Palpate the interscalene groove at level of the cricoid cartilage (C6)
-if groove not apparent ask pt to lift head |
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Techniques: Interscalene blk
Procedure: |
Sterile prep/drape
-Lido 1% local -25G 1.5 in or 22G 2in stimuplex needle insert perpendicular to the skin -slight medial & caudal deviation until parathesia or motor evoked response is elcited |
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Techniques: Interscalene blk
Procedure: |
30-40 ml of local w/ negative aspiration every 5ml
-0.5% Bupivacaine or Chirocaine w/ 1:200 K epi |
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The use of epi is
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a potent vasoconstrictor keeps med around longer
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If a hematoma develops the attempt of the block was
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unsucessful
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Techniques: Interscalene blk
Complications |
intra art inj to verterbral art (rapid seizure act)
-Epidural, subarach, subdurl inj -Pnemo -Stellate ganglion blk -> Horners sign (myosis, ptosis, anhidrosis) 30-50% of blks |
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Horners Sign
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Myosis: bld shot eye, small pupil
Ptosis: droopy eye Anhidrosis: Lack of sweating on one side of face |
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Techniques: Interscalene blk
Complications |
Phrenic nerve blk - feeling of heaviness one side of chest
Recurrent laryngeal nerve blk (30-50% -> hoarsness & weak voice) Infection, hematoma, nerve injury |
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Techniques of Axillary blk
Indications |
Any surg procedure mid humerus to hand
-not necessary to seek parathesia (use in child reduce fx's) -Less major complications -easy technique to master |
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Axillary blk can be used for the following
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AV fistula, Carpal tunnel syn
Ganglion cyst |
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Techniques of Axillary blk
Procedure: Pt position |
Supine, arm abd 90deg, ext rotated
-Brach art palpated, follow pulse prox far as possible -sterile prep/drape -1% lido directly over pulse |
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Techniques of Axillary blk
Procedure: |
25G 1.5in needle insert below art pulsation
-parathesias are elicited & after neg aspiration local anesthetic inj (40-45 mls bupivacaine or chirocaine 5mg/kg) |
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Techniques of Axillary blk
Procedure: use of nerve stimulator during inj. |
Use a nerve stimulator w/ 22G stimuplex needle, after appro muscle response inj 5ml local in 5ml incrmts w/ neg asp.
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Techniques of Axillary blk
Procedure: Trans-arterial approach |
22G 1.5in needle insert towards the artery until bright red blood asp.
-Move needle forward until bld asp ceases -Inj can be performed post or ant or in both locations |
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For an Axillary Blk it may also be necessary to blk the ____muscle to blk the musculocutaneous nerve (3-5mls)
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coracobrachialis (given into belly of the muscle)
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Techniques of Axillary blk
Complications: |
Intra-vascular (art or ven) w/ seizure
Elicitation of parathesia esp in multiple sites, inc incidence of post op neuropathy Hematoma & infection are rare |
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Regional anesth should not be done when pt is under gen anesth T or F
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T
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