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42 Cards in this Set
- Front
- Back
which vertebrae are the 'high points' of the spinal column when the pt is in the supine position?
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C5
L5 |
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Which vertebrae are the 'low points' of the spinal column when the pt is in the supine position?
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T5
S2 |
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which vertebrae are the 'high points' of the spinal column when the pt is in the prone position?
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T5
S2 |
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which vertebrae are the 'low point' of the spinal column when the pt is in the prone position?
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C5
L5 |
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which direction is rostral?
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toward the patient's head (same as cephalad)
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which parts of the vertebra do you usually hit with your needle?
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spinous process
lamina |
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which of the spinal meninges runs longitudinally?
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dura mater
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how far down the spinal column does the spinal cord go in adults? in newborns-1 year olds?
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adults: L1 in 90% of adults; L3 in 10% of adults
0-12 months: L3 |
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how many cervical nerves are there?
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8 (nerves C1-7 exit above the vertebra); nerve C8 exits above T1 vertebra). From T1 nerve down, nerve exits below the vertebra
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if you have sensory blockade at T6, where would you expect to have sympathetic and motor blockade?
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sympathetic: T4 (2 above sensory)
motor: T8 (2 below sensory) |
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which nerve fibers are easiest/fastest to block?
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smaller and myelinated fibers
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which nerve fibers are hardest to block/take longest?
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larger and unmyelinated fibers
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example of fiber that's very quick to block
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sympathetic (very myelinated)
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example of type of fiber that's hard to block
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motor nerve (bigger fibers)
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which type of fiber are the preganglionic autonomic fibers?
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B fibers (small; fast conduction)
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Where are the cardioaccelerator fibers?
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T1-T4
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significance of blocking cardioaccelerator fibers?
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unopposed vagal stimulation (drastic bradycardia)
bradycardia can be first sign that spinal/epidural is moving up |
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respiratory effects of neuraxial anesthesia?
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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) |
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GI effects of neuraxial anesthesia?
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increased peristalsis (can expedite return of GI function)
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GU effects of neuraxial anesthesia?
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urinary retention from atonic bladder and increased sphincter tone
pt should have Foley catheter if epidural used post-operatively |
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How many posterior and how many anterior arteries feed the spinal cord?
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Posterior: 2 (feed posterior 1/3 of cord)
Anterior: 1 (feeds anterior 2/3 of cord) |
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what is the major artery that feeds the spine?
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the artery of Adamkiewicz (arises from the aorta)
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what is seen with injury (e.g., prolonged clamping) of artery of Adamkiewicz?
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anterior spinal artery syndrome
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from skin to CSF, list the layers the needle passes through with a midline approach
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skin --> subcutaneous tissue --> supraspinous ligament --> infraspinous ligament --> ligamentum flavum --> epidural space --> dura mater --> arachnoid mater --> subarachnoid space (where CSF is)
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from skin to CSF, list the layers the needle passes through with a paramedian approach
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skin --> subcutaneous tissue (including paraspinous muscle) --> ligamentum flavum --> epidural space --> dura mater --> arachnoid mater --> subarachnoid space (where CSF is)
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two examples of why you might choose a paramedian approach instead of a midline approach
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elderly pts with calcified (tough) ligaments
thoracic cases (spinous processes in thoracic spine are at extreme angles) |
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landmark for C4
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clavicle
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landmark for T4-T5
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nipples
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landmark for T6-T8
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xiphoid
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landmark for T8
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lower edge of rib cage
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Landmark for T10
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umbilicus
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landmark for L1
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inguinal ligament
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landmark for L2-L3
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knee and below
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landmark for S2-S5
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perineal
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what level would you want to block for a chest surgery?
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C4 (epidural only)
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what level would you want to block for upper abdominal surgery and Caesarean sections?
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T4-T5
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what level would you want to block for an abdominal surgery (e.g., appy, GYN, ureter/renal, intestinal)
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T6-T8
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what level would you want to block for abdominal surgeries (in general)?
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T8
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What level would you want to block for a TURP, hip, vaginal delivery?
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T10 (preferred for TURP)
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What level would you want to block for lower limb surgery, or even a TURP
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L1 (T10 preferable for TURP)
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What level would you want to block for foot surgery?
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L2-L3
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What level would you want to block for anal/perineal surgery?
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S2-S5
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