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42 Cards in this Set

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which vertebrae are the 'high points' of the spinal column when the pt is in the supine position?
C5
L5
Which vertebrae are the 'low points' of the spinal column when the pt is in the supine position?
T5
S2
which vertebrae are the 'high points' of the spinal column when the pt is in the prone position?
T5
S2
which vertebrae are the 'low point' of the spinal column when the pt is in the prone position?
C5
L5
which direction is rostral?
toward the patient's head (same as cephalad)
which parts of the vertebra do you usually hit with your needle?
spinous process
lamina
which of the spinal meninges runs longitudinally?
dura mater
how far down the spinal column does the spinal cord go in adults? in newborns-1 year olds?
adults: L1 in 90% of adults; L3 in 10% of adults

0-12 months: L3
how many cervical nerves are there?
8 (nerves C1-7 exit above the vertebra); nerve C8 exits above T1 vertebra). From T1 nerve down, nerve exits below the vertebra
if you have sensory blockade at T6, where would you expect to have sympathetic and motor blockade?
sympathetic: T4 (2 above sensory)

motor: T8 (2 below sensory)
which nerve fibers are easiest/fastest to block?
smaller and myelinated fibers
which nerve fibers are hardest to block/take longest?
larger and unmyelinated fibers
example of fiber that's very quick to block
sympathetic (very myelinated)
example of type of fiber that's hard to block
motor nerve (bigger fibers)
which type of fiber are the preganglionic autonomic fibers?
B fibers (small; fast conduction)
Where are the cardioaccelerator fibers?
T1-T4
significance of blocking cardioaccelerator fibers?
unopposed vagal stimulation (drastic bradycardia)

bradycardia can be first sign that spinal/epidural is moving up
respiratory effects of neuraxial anesthesia?
in healthy patients, usually of little significance.

can decrease FRC d/t paralysis of abdominal muscles

paralysis of intercostal muscles interferes with ability to cough

if respiratory centers very hypoperfused d/t hypotension, can have apnea (not as likely)
GI effects of neuraxial anesthesia?
increased peristalsis (can expedite return of GI function)
GU effects of neuraxial anesthesia?
urinary retention from atonic bladder and increased sphincter tone

pt should have Foley catheter if epidural used post-operatively
How many posterior and how many anterior arteries feed the spinal cord?
Posterior: 2 (feed posterior 1/3 of cord)
Anterior: 1 (feeds anterior 2/3 of cord)
what is the major artery that feeds the spine?
the artery of Adamkiewicz (arises from the aorta)
what is seen with injury (e.g., prolonged clamping) of artery of Adamkiewicz?
anterior spinal artery syndrome
from skin to CSF, list the layers the needle passes through with a midline approach
skin --> subcutaneous tissue --> supraspinous ligament --> infraspinous ligament --> ligamentum flavum --> epidural space --> dura mater --> arachnoid mater --> subarachnoid space (where CSF is)
from skin to CSF, list the layers the needle passes through with a paramedian approach
skin --> subcutaneous tissue (including paraspinous muscle) --> ligamentum flavum --> epidural space --> dura mater --> arachnoid mater --> subarachnoid space (where CSF is)
two examples of why you might choose a paramedian approach instead of a midline approach
elderly pts with calcified (tough) ligaments

thoracic cases (spinous processes in thoracic spine are at extreme angles)
landmark for C4
clavicle
landmark for T4-T5
nipples
landmark for T6-T8
xiphoid
landmark for T8
lower edge of rib cage
Landmark for T10
umbilicus
landmark for L1
inguinal ligament
landmark for L2-L3
knee and below
landmark for S2-S5
perineal
what level would you want to block for a chest surgery?
C4 (epidural only)
what level would you want to block for upper abdominal surgery and Caesarean sections?
T4-T5
what level would you want to block for an abdominal surgery (e.g., appy, GYN, ureter/renal, intestinal)
T6-T8
what level would you want to block for abdominal surgeries (in general)?
T8
What level would you want to block for a TURP, hip, vaginal delivery?
T10 (preferred for TURP)
What level would you want to block for lower limb surgery, or even a TURP
L1 (T10 preferable for TURP)
What level would you want to block for foot surgery?
L2-L3
What level would you want to block for anal/perineal surgery?
S2-S5