A review to material for test 3 on peripheral nerve blocks.
C5-C8
C2-T2
T1-T2
C1-C4
Below, above
Above, below
Beside, above
Below, Beside
Trunks, Cords, Roots, Divisions, Branches
Cords, Roots, Branches, Trunks, Divisions
Roots, Trunks, Divisions, Cords, Branches
Branches, Divisions, Trunks, Roots, Cords
Median Nerve
Ulnar Nerve
Scalene Nerve
Radial Nerve
Extension of wrist and fingers
Pronation of forearm and flexion of wrist
Flexion of pinky finger and ulnar wrist deviation
Contraction of deltoid muscle
Ulnar
Radial
Medial
Obturator
C5-C6
C6-C8
C2-C4
C8-T1
Ulnar
Median
Radial
None of Above
Ulnar
Median
Radial
None of Above
Ulnar
Median
Radial
None of Above
Median
Scalene
Radial
Ulnar
Flexion of pinky finger and ulnar wrist deviation
Extension of wrist and fingers
Pronation of forearm and flexion of wrist
Contraction of deltoid muscle
Scalene nerve
Axillary nerve
Median nerve
Musculocutaneous nerve
It supplies motor enervation to the deltoid muscle it also supplies sensory enervation to the same area both anteriorly and posteriorly
Sensory it supplies the thumb, index, middle and half of the ring finger on the palmar(bolar) side on the dorsum of the hand it supplies the distal 3rd of the thumb and index fingers.
Stimulation of the nerve causes extension of the wrist.
Provides motor enervation to biceps and coracobrachialis, sensory to lateral aspect of forearm.
40 ml
10 ml
25 ml
2-5 ml
Sciatic nerve
Brachial Plexus nerve
Femoral nerve
Spinal cord
Lateral femoral cutaneous
Ilioinguinal
Obturator
Femoral
Femoral
Sciatic
Lateral Femoral Cutaneous
Ilioinguinal
Ilioinguinal
Obturator
Lateral Femoral Cutaneous
Femoral
True
False
Sitting
Lateral
Prone
Supine
Sciatic
Lateral Femoral Cutaneous
Femoral
Obturator
2 cm medial from femoral pulse
2 cm caudad from femoral pulse
2 cm distal from femoral pulse
2 cm lateral from femoral pulse
5 ml’s
2-3 ml’s
10 ml’s
You don’t have to after the initial aspiration.
Anterior Superior Iliac spine
Sacral Hiatus
The femoral artery
Superior lateral corner of pubic tubercle
Provides motor enervation to all muscles distal to knee
Supplies sensory fibers to posterior hip
Supplies all sensory enervation to lower extremity(below knee) and foot
Provides motor enervation to hamstring
Superior Lateral corner of Pubic Tubercle
Posterior superior iliac spine
Greater Trochanter of hip
Sacral Hiatus
2-5 cm above the posterior crease of knee
7-10 cm above the posterior crease of knee
10-12 cm above the patella on anterior portion of thigh
2-3 cm below the posterior crease of knee
Tibial Nerve
Saphenous Nerve
Peroneal nerve
Radial nerve
Wrist and thumb flexion
Foot dorsiflexion
Twitching of lateral thigh
Plantar flexion
Deep Peroneal nerve
Dorsal Digital nerve
Sural Nerve
Saphenous Nerve
Deep Peroneal nerve
Saphenous Nerve
Sural Nerve
Superficial peroneal Nerve
Trigeminal
Facial
Opthalmic
Oculomotor
Site of injection is just below the superior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing supranasally.
Site of injection is just above the inferior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing supranasally.
Site of injection is just below the superior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing infranasally.
Site of injection is just above the inferior orbital rim, where an angled needle is passed into the intraconal region with the patient gazing to the left.
Globe Perforation
Neurogenic Apnea
Optic Nerve Atrophy
Retrobulbar Hemorrhage
Bradycardia
Hypertension
PVC’s
Tachycardia
Pt currently taking daily Coumadin
Pt with advanced CHF and CAD
Pt with severe myopia
Pt with open corneal abrasion
Loss of ocucephalic reflex
Loss of oculocardiac reflex
Patient sedation
All the above
Pt c/o ringing in ears and metallic taste in mouth
Permanent pt blindness
Pt unconsciousness and seizures
Retrobulbar hemorrhage
Slow down your rate of injection, and then administer rest of anesthetic.
Immediately notify MD and prepare pt for cardiac bypass, your plasma concentration is most likely too high now.
Immediately stop injection, start lipid infusion, monitor patient, your plasma concentration should still be low enough to reverse this.
Comfort the patient that this is normal to experience and deliver rest of anesthetic quickly.
Trigeminal
Glosspharyngeal
Spinal Accessory
Vagus
25
22
20
18
Styloid process posterior to angle of jaw
Greater cornu of Hyoid bone
Tonsillar pillar
Cricothyrohyoid membrane
2 cm caudad to Styloid process posterior to angle of jaw
Directly above greater cornu of Hyoid bone
Posterior to Tonsillar pillars
Through the Cricothyrohyoid membrane
Radial Nerve
Ulnar Nerve
Medial Nerve
Musculocutaneous nerve
Radial
Ulnar
Axillary
Medial
Lidocaine 0.5% with epi
Bupivacaine 0.75% plain
Lidocaine 0.5% plain
Bupivacaine 0.75% with epi
Axillary artery below the pectoralis major muscle at the insertion of the bicep muscle.
The brachial pulse and medial epicondyle
The coracoid process, distal portion of the clavicle
The interscalene groove, located posterior to the clavicular insertion of the SCM.
Axillary artery below the pectoralis major muscle at the insertion of the bicep muscle.
The brachial pulse and medial epicondyle
The coracoid process, distal portion of the clavicle
The interscalene groove, located posterior to the clavicular insertion of the SCM.
A diabetic pt with peripheral neuropathy
A pt with aortic stenosis
A sickle cell pt
An awake pediatric patient
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