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27 Cards in this Set
- Front
- Back
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Local anesthetics work best on which axons?
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Small peripheral, myelinated fibers that fire frequently. (use dependent)
pain and temp > pressure > motor > proprioception |
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Two most commonly used local anesthetics?
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Lidocaine: short acting.
Bpivacaine: longer acting. can target (sensory > motor) by alternating concentrations. |
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Maximal dosing of the two most commonly used local anesthetics?
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Lidocaine - epi: 5 mg/kg
Lidocaine + epi: 7 mg/kg Bupivacaine - epi: 1.5 mg/kg Bupivacaine + epi: 3 mg/kg |
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What dilution to use epinephrine in a local block?
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1:200,000
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What body sites not to use epinephrine in?
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Nose, hose, finger, toes.
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Opioid effects on CV, GI, GU?
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CV: bradycardia
GI: decreased motility, biliary constriction GU: decreased renal function |
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Morphine dosing?
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Loading: 0.10 mg/kg
Maintenance: 0.8 - 10.0 mg/hr titrated to pain |
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Morphine duration?
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Up to 4 hours.
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Meperidine dosing?
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15-35 mg/hr q4 hr prn
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Meperidine dosing?
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Up to 4 hours.
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Fentanyl dosing?
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1 ug/kg slowly (sedation often at 3-4 ug/kg)
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Fentanyl duration?
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20-30 min.
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Naloxone dosing?
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0.4 mg
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Naloxone duration?
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Variable, but shorter half life than agonists, therefore multiple dosings may be required.
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Metabolism of benzos?
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Metabolized in liver, excreted in urine.
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Midazolam dosing?
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1-2 mg/dose
dose q 5-7 min |
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How to reverse benzos?
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Flumazenil 0.2 mg iv
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Prototypical dissociative anesthetic?
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Ketamine.
Mechanism: blocks NMDA receptors. Dose: 1 mg/kg Duration: 15-20 min Occasional hallucinations on emergence: tx with midazolam. May increase salivation: tx with atropine. |
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Propofol half life?
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30 min.
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Describe the hematoma block?
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For reduction and postreduction analgesia of closed fractures:
1. enter site with large bore needle 2. aspirate hematoma replace with 10-15 mL lidocaine-epi 3. wait 10 min 4. reduce fracture |
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Describe the digital nerve block?
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1. pronate hand
2. inject 2 mL per nerve lateral and medial just distal to the MIP (total of 8 mL) |
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Describe the wrist block of the median nerve?
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1. supinate forearm
2. insert needle between the palmaris longus and the flexor carpi radialis tendons, two cm proximal to the wrist flexion crease 3a. if paresthesia is elicited, inject 3-5 mL at this site 3b. if no paresthesia, inject 5 mL in a fan-shaped fashion |
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Describe the wrist block of the ulnar nerve?
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1. supinate forearm
2. insert needle radial to the flexor carpi ulnaris, 6 cm proximal from the wrist crease 3. inject 8-10 ml of local |
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Describe the wrist block of the radial nerve?
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1. pronate the hand
2. start at the level of the snuff box, and continue over the entire dorsum of the hand 3. 5-8 mL of local will be required |
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Describe the elbow block?
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Need to block 4 nerves: radial, ulnar, median, lateral antebrachial cutaneous:
Median: draw a line between the medial and lateral epicondyles. Insert needle just medial to brachial artery, obtain paresthesia, inject 5 mL. Ulnar: draw a line between the medial epicondyle and the olectranon of the flexed elbow. Inject 5 mL superficially halfway between these two points, 1 cm proximal. Radial/Musculocutaneus: inject 2 cm lateral to the biceps tendon along the intercondylar line. |
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Describe the axillary block?
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1. patient supine
2. palpate axillary artery 3. inject in 4 quadrants to cover the musculocutaneus, radial, ulnar, median. |
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Describe the ankle block?
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Must block all 5 nerves: tibial, deep peroneal, superficial peroneal, superficial saphenous, sural.
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