Term
| What should you do with the tourniquet cuffs prior to starting the case? |
|
Definition
| Always check that equipment is working and proper cuff sizes are available. |
|
|
Term
| What size angiocath should be placed prior to IVRA block? |
|
Definition
| a 22 or 20g IV in the operative site (more distal is best) |
|
|
Term
| What should the placement of the 2 tourniquets be? |
|
Definition
| Side by side. They should not overlap and both should be tested. |
|
|
Term
| How long should the arm be elevated to allow for exsanguination? |
|
Definition
|
|
Term
| Once exsanguinated, how high should the tourniquets be inflated? |
|
Definition
* 200-250 mmHg for upper arm
* 50-100 mmHg above the occlusion pressure
* 150mmHg above systolic pressure (Gayle does this) |
|
|
Term
| What type of bandage is the elevated arm wrapped in? |
|
Definition
|
|
Term
| Hoe fast should you inject the local in a Bier block? |
|
Definition
| over 60-90 seconds. Aspirate every 10cc to make sure you are in a vein. |
|
|
Term
| How fast is the onset of a Bier block after successful exsanguination? |
|
Definition
|
|
Term
| When would you stop injecting the local? |
|
Definition
*you get a lot of blood back (you may have hit an artery)
*radial pulse is felt
*hand becomes flushed or congested (purple)
*vein blows
*tourniquet fails |
|
|
Term
| When should you consider deflating the cuff(s)? |
|
Definition
| **DO NOT allow deflation of cuff if LESS than 20min has occurred. If 40min has elapsed, you can deflate. If between this time, consider deflating and inflating as a cycle. |
|
|
Term
| When is a Bier block MOST suitable? |
|
Definition
| surgeries of the forearm and hand |
|
|
Term
| What are the contraindications to using a Bier block? |
|
Definition
1. Pt. REFUSAL
2. co-morbidities eg. sickle cell dx or trait, PVD, Reynaud's
3. Tissue infections
4. allergy to medication
5. liver dx or dysfunction
6. debilitated pts.
7. convulsive disorders
8. morbid obesity
9. myasthenia gravis |
|
|
Term
| What drugs are commonly used for the local? |
|
Definition
*Lidocaine 0.5% preservative free WITHOUT epinephrine (50ml)
- 15-30mg toradol can also be used |
|
|
Term
| Preparation of the pt. before block includes: |
|
Definition
1. giving versed or narcotics for pt. relaxation and toleration of tourniquet use.
2. Pt should be NPO
3. IV access and monitors should be on NON OPERATIVE extremity
4. check for loss of radial pulse with tourniquets (this can be done with pulse ox) |
|
|
