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88 Cards in this Set

  • Front
  • Back
what is the definition of ultrasound
energy generated by sound waves of 20,000 or more vibrations per sec
medical ultrasound is what
sound waves in the 2-12 million cycles per second (MHz) range which are produced and detected by transducers contained in a hand-held probe
with ultrasound the tranducer is what and does what
*is piezoelectric crystals

*change electrical voltage into sound waves and reflected sound waves back into voltage
the image seen on the screen with ultrasound is made up of what
many individual scan-lines
with ultrasound the scan-lines seen on the screen each scan-line is made from what
the transmitted and received ultrasound pulse from one set of crystals
tissue penetration or the depth to which sound waves produced by the transducer will travel and reflect largely depends on what
upon the frequency range of the transducer
superficial structures with ultrasound are how deep
0-3 cms
superficial structures with ultrasound require what kind of transducer frequencies
HIGH

-6-12 MHz
what is an example of a superficial structure with ultrasound
interscalene
deeper structures with ultrasound are how deep
4-8 cms
deeper structures with ultrasound require what kind of transducer frequencies
LOWER

-2-4 MHz
what is an example of a deeper structure with ultrasound
SCIATIC
the denser or more rigid the layer encoutered with US the lesser or greater the amt of wave that will be reflected
GREATER

(example BONE)
bone is an example of what kind of waveform on ultrasound
HYPERECHOIC
the less dense or less rigid the layer encountered on US the less or greater the wave will be reflected
LESS

(example VESSELS)
the lack of a reflected wave leaves what on the US screen
a blackened area
a vessel is an example of what on the US screen
HYPERECHOIC
the side of the US probe that has the perpendicular lines should be oriented how
to the PATIENTS right
the most common way to view a target nerve is to hold the probe how
at a RIGHT angle to the long axis of the nerve (transverse view)
what is an out of plane approach
if the needle is directed perpendicular to the long axis of the probe
with US what is the longitudinal view
the longitudinal edge of the probe is held facing the long axis of the nerve
with US what is the most difficult view for needle placement since it is difficult to hold probe centered
longitudinal view
with US what is an in plane approach
if the needle is introduced parallel to the long axis of the probe
with US what view is a good view to appreciate anatomy and distribution of LA AFTER it has been placed
in plane approach
what is toggle
making changes to the angle at which the tranducing probe is held to the body surface can result in very diff images being produced
with central line placement US allows you to differentiate b/t what structures
IJ and carotid artery
what is the IJ like with US when placing a central line
it can be compressed with the probe and will usually distend when pt placed in trendelenburg
what is the carotid artery like with US when placing a central line
it pulsates and will NOT compress with pressure
with central line placement US allows you to view overlap of what structures
IJ and carotid artery
why are pts placed in trendelenburg for central line placement
to decrease risk for air emboli
what are the advantages for using US for blocks/line placement
*procedures are done under direct vision (#1)
*allows for respositioningof the needle after injection
*LA placement in relation to nerve location is seen immediately
*lower volumes of LA can be used d/t more accurate placement around the nerve
an interscalene block produces what kind of block
a dense, solid brachial plexus block
an interscalene block is best suited for what kind of procedures
procedures of the shoulder and upper arm
the interscalene is relatively easy to locate where
within the brachial plexus sheath b/t the middle and anterior scalene muscles
what is the pt positioning for an US for an interscalene block
*supine or head slighly elevated
*both arms at side
*head turned away from side being blocked
*US screen should be opposite from the blocker
when scanning with the US for a interscalene block start out by locating what
the brachial plexus in the supraclavicular space and follow it back to the interscalene space
when scanning with US for an interscalene block after identifying the subclavian artery where in relation to the artery is the brachial plexus
on the postero-lateral side of the artery--they are a group of smaller circles bunched together
when performing an interscalene block under US tech how do you know that you are passing b/t the ant and middle scalene muscles
while tracing the nerves back up the neck you will notice that they line up in a vertical column that indicates that you are passing thru the ant and middle scalene
what needle approach with US interscalene is less discomfort and avoids the jugular veins and carotid
IN-PLANE tech
with an interscalene US tech you want to keep the needle where
b/t the scalene muscles and within the brachial plexus sheath
when doing an interscalene with US if the injection goes into the scalene muscle what should be done
stop injecting and redirect the needle between the muscles again
when performing an interscalene block with US what are some tips to help AVOID a phrenic nerve block
*approch brachial plexus at a lower point
*use less LA volume (6mls)
*use a lower concentration of LA-may not be sufficient for sx motor block but works well for post-op pain control
an axillary block with US produces what kind of block with what kind of onset
*DENSE block

*RAPID onset
an axillary block with US is suitable for what kind of procedures
*forearm

*hand
what is the disadvantage of axillary block with US
requires the repositioning of the needle min 3 times to provide coverage of the nerve targets
what is the pt positioning for an axillary block with US
*supine
*arm should be ABducted with elbow flexed and hand near head
*positon yourself facing axilla
when scanning for axiallary block with US hold the probe how
transverse to the long axis of the brachial plexus
when scanning for axillary block with US you should place the probe where
over the axillary artery high on the upper arm close to the junction with the shoulder
when scanning for axillary block with US what should you maintain in the center of the pic
axillary artery
when scanning for axillary block with US the nerves of the brachial plexus will appear much brighter (hyperechoic) where
in the axilla
for in plane needle approach for an axillary block with US the needle should be directed from where
the top side
for an out of plane needle approach for an axillary block with US what is done
this approach uses 1 cm long skin wheal parallel to the probe to change entry points
a femoral block with US is a reliable block for post-op pain relief for what procedures
*ANTERIOR thigh and knee

*MEDIAL portion of lower leg
a femoral block using US is for pain relief for pain involving what structures
POSTERIOR portion of

*upper leg

*knee

*lower leg
a femoral block using US is commonly combined with what other block
SCIATIC block
what is the positioning for a femoral block using US
*supine
*stand along side upper thigh
*US machine should be opposite your position
with a femoral block with US what should scanning depth be set at
4-5 cms
with a femoral block with US what artery do you want to locate
FEMORAL
with femoral block with US you want to stay above where with the femoral artery
the bifurcation
when performing a femoral block with US the space containing the femoral nerves will resemble what
a triangular shape
what are the injections needed for a femoral block with US
3 SEPARATE injections

*just lateral to femoral art
*at the angle below the artery
*at the lateral tip of triangle
the sciatic nerve blocked in the popliteal area will provide post-op pain control for sx where
of the lower leg and foot
what is the exception to pain control provided by block of the sciatic nerve blocked in the popliteal area
the medial area of the lower leg that is innervated by the femoral nerve
in order to completely block the lower leg and foot what needs to be done
the addition of a saphenous or femoral block to the sciatic block is required
the tibial nerve is generally easy to find where and why
*easy to find in the popliteal space

*b/c it lies closest to the skin at that point
the tibial nerve lies next to what
the popliteal artery
the sciatic nerve bifurcates into what at approx 8 to 10 cm cephlad of the popliteal crease
the tibial and common peroneal nerves
when performing a popliteal block with US where should injection of the LA be
above the bifurcation of the sciatic nerve
what is the postioning for a popliteal sciatic block with US
*pt should be prone or lateral
*position yourself to have access to the popliteal space and thigh
*US machine should be opposite you
when scanning for a popliteal sciatic you should place the probe where
over the popliteal crease
when scanning with US for a popliteal sciatic block what should scanning depth be set at
4-5 cm
when scanning for a popliteal sciatic block with US what should you identify first
the popliteal artery

-be careful not to mistake this for the vein that is freq seen there
when scannin for a popliteal sciatic block with US what should be done after the popliteal artery is identified
look cephald and lateral for the tibial nerve
when perfoming a popliteal sciatic block with US where should you place the block
in the area where the 2 nerves (common peroneal & tibial) lie side by side
when performing a popliteal sciatic block with US if at any time you feel like you may be mistaking tendon for nerve you can do what
flex the knee

-tendons move, nerves dont
the fascia iliaca block with US is a simple block for post-op pain relief in what procedures
procedures involving:

*hip

*ant thigh

*knee
fascia iliaca block with US is esp useful when
*fx hips

*proximal to mid-femur fx

*total hip athroplasty
what are the 2 "pops" with a fascia iliaca
*1st pop is through fascia lata

*2nd pop is through ilicus fascia
what is the positioning with fascia iliaca with US
*pt is supine
*stand alongside upper thigh
*US machine should be opposite your position
when scanning with fascia iliaca with US where should you place the probe
in a perpendicular orientation over the inguinal ligament b/t the ant superior iliac spine & the femoral artery
what should you locate with the probe when scanning for a fascia iliaca with US
*femoral artery

*edge of ilium
when scanning for a fascia iliaca with US the muscle overlying the bone is what
ILIOSOAS
when scanning for a fascia iliaca with US the bright band covering the muscle is what
ILIACUS FASCIA
with needle approach for a facsia iliaca with US what is the best approach
IN PLANE tech
how should you insert the needle for a fascia iliaca with US
with the bevel up near the inferior edge of the probe
when performing a fascia iliaca with US while advancing the needle what should occur
you should feel the resistance of the fascial layer
when performing a fascia iliaca with US after puncturing the iliacus fascia what should you do
stop advancement so that the needle tip lies close to the most superficial level of the iliopsoas muscle
when performing a fascia iliaca with US be sure the LA volume is spreading in what direction
SUPERIOR