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20 Cards in this Set
- Front
- Back
Rank the set up time for brachial plexus blocks from fastest to slowest?
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interscalene, supraclavicular, axillary
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What are contraindications to brachial plexus blocks?
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local infection and pneumothorax
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What tissue forms the axillary perivascular sheath?
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prevertebral fascia
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When can you use an axillary block for anesthesia for procedures on the arm?
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distal to the elbow
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What problem can you encounter when doing an axillary block as the anesthetic for procedures? How can you solve it?
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musculocutaneous nerve often exits distal to where the axillary block is performed, which provides sensation to the lateral aspect of the forearm; injection of lidocaine 1% 3-5 cc into coracobrachialis will block this nerve
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What nerves are frequently missed with the axillary block?
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intercostal brachial nerve, median cutaneous nerve, musculocutaneous nerve
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How can you block both the intercostobrachial nerve and median cutaneous nerve if missed by an axillary block?
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cuff of anesthesia: injecting local anesthetic circumferentially and superficially around the arm as the axillary block needle is needle is being removed
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How does the axillary nerve block progress?
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proximal to distal; the outside of the nerve innervates the proximal region and the core innervates the distal region
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If after an axillary block patient is still having pain in his hand what should you do?
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wait block probably needs more time to set up
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what are complications of the interscalene block?
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vertebral artery puncture, pneumothorax, phrenic nerve paralysis, spinal or epidural block, brachial plexus injury, recurrent laryngeal nerve blockade
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Where do the interscalene and supraclavicular block provide excellent analgesia?
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proximal to the elbow including the shoulder
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If you do an interscalene block for analgesia of the arm what block is often necessary to supplement the analgesia to the forearm?
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ulnar(unless large volumes are used the lower trunk anesthesia may be missed)
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How is a supraclavicular block performed?
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skin should be entered 1-2 cm above the midpoint of the clavicle when the first rib is contacted the needle should be moved in a slightly anterior posterior direction until paresthesia is elicited
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What are complications associated with a supraclavicular block?
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pneumothorax, phrenic nerve paralysis, horner's syndrome(ptosis, miosis, anhidrosis, sinking in of eyeball, and flushing of the affected side), nerve damage and neuritis
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How can you tell if there is a median nerve injury?
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injury of papal benediction(little and ring fingers are flexed, while other fingers are extended)
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what is the agent of choice, concentration and dose for a bier block?
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0.5% lidocaine 50mL
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what is the minimum and maximum tourniquet time for a bier block?
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minimum-30min, max-2hrs
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What are the advantages of a bier block?
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excellant anesthesia to forearm, hand, and foot, technical ease and reliability, duration and extent of anesthesia are reliable and predictable and recovery is rapid
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what are the disadvantages of a bier block?
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limitations imposed by tourniquet time, problems with exsanguination in certain cases such as fracture or laceration
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How should the tourniquet be released for a bier block?
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alternating inflation and deflation at 5-10 s intervals for a minute or two
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