OSCE Regional Ultrasound Review

Transcription

1 OSCE Reginal Ultrasund Review Nick Schiavni, MD Olivia Rman, MD Department f Anesthesilgy University f Clrad Denver Each OSCE scenari will address ne f the fllwing skills: Cmmunicatins and Prfessinalism Technical Skills Applicatin f Ultrasngraphy This study guide will fcus n preparatin fr the Applicatin f Ultrasngraphy scenaris Using an ultrasund prbe n a simulated patient, the examinee will be expected t prduce the apprpriate image, describe simulated needle placement, and identify all pertinent anatmy n a screensht f the image yu prduced. The examinee perates the ultrasund prbe & can ask the examiner t adjust depth/gain. They then ask the examiner t freeze the image. This image is what will be used during questining by the examiner. The fllwing prcedures may be tested Vascular Cannulatin Internal Jugular Vein Cubital Fssa Vessels Radial Artery Femral Vessels Nerve Blcks Femral Adductr Canal (Saphenus) Ppliteal Transversus Abdminis Plane (TAP) Interscalene

2 Supraclavicular This guide will review prper patient psitining, apprpriate ultrasund prbe placement, and pertinent ultrasund image anatmy fr the abve nerve blcks. This guide, including the images within, is t be used fr nn-prfit educatinal purpses nly.

3 FEMORAL NERVE BLOCK Patient Psitining Supine with slight external rtatin f hip Prbe Placement Transverse, in the inguinal crease Obtaining Image/Pertinent Anatmy Slide prbe medially r laterally until pulsating femral artery is identified Remember pneumnic NAVL (Lateral t medial) Identify the fllwing structures Femral nerve Femral artery Femral vein Fascia iliaca Ilipsas muscle In-Plane (lateral t medial) Superficial r deep apprach acceptable Visualize lcal anesthetic spread arund nerve in area deep t fascia iliaca and superficial t ilipsas muscle

4 Adductr Canal (Saphenus) Blck Patient Psitining Supine with knee slightly flexed and leg externally rtated (frg leg psitin) Prbe Placement Transverse, medial aspect f mid thigh Obtaining Image/Pertinent anatmy Find femur, slide prbe medially until the pulsating femral artery is visualized within the canal The nerve is nt always well visualized Identify the fllwing structures Femur Superficial femral artery Sartrius (medial) and vastus medialis (lateral) muscles In plane (lateral t medial) Visualize lcal anesthetic spread deep t Sartrius and arund the femral artery. Often see the artery being pushed away by lcal anesthetic

5 Ppliteal Blck Patient Psitining Supine with leg rest/supprt, elevating the knee enugh t place US prbe Can als be perfrmed while patient is in the prne psitin Prbe Placement Transverse in ppliteal crease between tendns f hamstring muscles, then apprximately 5cm cephalad f crease Obtaining Image/Pertinent anatmy Identify ppliteal artery at a depth f apprximately 3-4cm Lateral and superficial t artery shuld be the tibial and cmmn perneal nerves (CPN is mst lateral) Slide the prbe prximal, identifying where the tw nerves jin t frm the sciatic nerve Identify the fllwing structures: Ppliteal artery Cmmn perneal nerve Tibial nerve Sciatic nerve Biceps femris (lateral) Semitendinsis and semimembransus muscles (medial) In plane (lateral t medial) Visualize lcal anesthetic spread prximally and distally, separating the tw nerves

6 Transversus Abdminis Plane (TAP) Blck Patient Psitining Supine, arm extended ver head Prbe Placement Transverse n the abdmen Anterir axillary line, between iliac crest and cstal margin Obtaining Image/Pertinent anatmy Lcate the three muscle layers (slight mvements cephalad r caudad may assist in identifying these layers) Identify the fllwing structures: Subcutaneus tissue External Oblique muscle Internal Oblique muscle Transverse Abdminal muscle Peritneum In plane (medial t lateral) Visualize lcal spread between the internal blique and the transversus planes

7 Interscalene Blck Patient Psitining Sitting with HOB 30 degrees with neck turned away frm blck side Prbe Placement Transverse n neck, 3-4 cm cephalad t clavicle, just lateral t SCM Obtaining Image/Pertinent anatmy Start just cephalad t clavicle at the midclavicular line. Visualize subclavian artery and divisins f the brachial plexus Trace the brachial plexus cephalad, t the level f cricid cartilage, apprximately 2-3cm abve clavicle Classic traffic light view between the bellies f the anterir and middle scalene muscles Identify the fllwing structures: C5, C6, C7 nerve rts Sterncleidmastid, Anterir Scalene, and Middle Scalene muscles Cartid artery, internal jugular vein (if visualized medially) C6 transverse prcess In plane (lateral t medial) Visualize lcal anesthetic spread between the C5 and C6 nerve rts fr shulder surgery

8 Supraclavicular Blck Patient Psitining Semisitting psitin with head facing away frm blck side Prbe Placement Transverse, just cephalad t clavicle at the midclavicular line Obtaining Image/Pertinent anatmy Find the bundle f grapes just lateral and superficial t the pulsating subclavian artery Identify the fllwing structures: Brachial Plexus Middle scalene muscle Subclavian artery 1 st rib Lung/pleura In-plane (lateral t medial) Visualize adequate spread surrunding the brachial plexus. D nt frget t inject lcal anesthetic in the crner pcket (area between subclavian artery, 1 st rib, and brachial plexus plexus) if C8/ulnar blckade is indicated

9 References 1. "Ultrasund Guided Techniques Archives." NYSORA The New Yrk Schl f Reginal Anesthesia. Web. 2. ASA 2016 Ultrasund Guided Adductr Canal Blck (blckade) Femral Nerve Blck (blckade). Yutube, 12 Oct Web. 3. Ultrasund Guided Adductr Canal Blck fr Benign Tumr resectin by Dr. Tugce Yenicak. ESRA Academy - Official ELearning Prtal f ESRA (Eurpean Sciety f Reginal Anaesthesia & Pain Therapy). 8 Sept Web.

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