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Organisation of the Body

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Question
Answer
show A narrow, hollow syringe a drug  
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show Tying a band around the upper arm removes all the blood from the limb Anaesthetic can then be injected to produced a rapid numbing of the limb that does not spread around the body If this did spread e.g. blood flow restored, the heart would stop  
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show Skin Fat Interspinous ligament Ligamentum flavum Epidural space Dura  
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show Below the spinal cord in the lumbar cerebrospinal fluid This eliminates the chance of damaging the spinal cord, although individual nerves maybe affected  
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Numbers of vertebrae and spinal nerves   show
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show Between L1/L2 in an adult It initially reaches the end of the spine but regresses during development  
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Cauda Equina   show
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show L4 is level with the top of the pelvis, so can be used to identify the correct injection site The patient should be flexed forward to allow access to the dura membranes which are usually covered by bone  
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Role of dermatomes in anaesthetic   show
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Drugs used in spinal anaesthesia   show
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Volume of drug used in spinal anaesthesia   show
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show Into the lumbar CSF which bathes the cauda equina in the region L2-L5  
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show Rapid onset - 5-15 mins May instantly produce effects Lasts 1- 2 hours  
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show Lock all nerves and modalities below the level of the injection, typically T10 downwards Small nerves (temperature and pin prick sensations) are blocked before larger nerves (voluntary motor) Spread depends on posture  
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Adverse effects of spinal anaesthesia   show
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show Pain relief and muscle paralysis during surgery - used alongside general anaesthesia  
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show Needle in the epidural space Can be accessed via the sacral hiatus Contains fatty tissue and blood vessels - bleeding may occur when the needle is inserted  
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Drugs used in epidurals   show
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show Large - 20ml The epidural space is voluminous and you want to fill this up  
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Site of epidural   show
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show Slow onset - 10-30 mins Lasts up to 6 hours  
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show Block of all nerves and modalities in a band around the body at the levels reached by the injection Typically T10-S1 for a lumbar epidural Spread depends on posture  
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Adverse effects of epidurals   show
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show Commonly used in labour for childbirth as a form of analgesia with bupivacaine 0.125-0.25% The Tuohy technique and using a catheter allows infusion or top ups for prolonged use Very useful in pain relief and muscle paralysis in surgery  
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