Needle Placement Visualize local spread between the internal oblique and the transversus In plane (lateral to medial) planes Visualize local anesthetic spread proximally and distally, separating the two nerves Interscalene Block Transversus Abdominis Plane (TAP) Block Patient Positioning Sitting with HOB 30 degrees with neck turned away from block side Patient Positioning Supine, arm extended over head Placement Transverse on neck, 3-4 cm cephalad to Probe Placement clavicle, just lateral to SCM Transverse on the abdomen Anterior axillary line, between iliac crest Obtaining anatomy and costal margin Start just cephalad to clavicle at the midclavicular line. Visualize subclavian Obtaining Image/Pertinent anatomy artery and divisions of the brachial plexus Locate the muscle layers (slight Trace the brachial plexus cephalad, to movements cephalad or caudad may the level of cricoid cartilage, assist in identifying these layers) approximately 2-3cm above clavicle Identify the following structures: Classic traffic light view between the Subcutaneous tissue bellies of the anterior and middle External Oblique muscle scalene muscles Internal Oblique muscle Identify the following structures: Transverse Abdominal muscle C5, C6, C7 nerve roots Peritoneum Sternocleidomastoid, Anterior Scalene, and Middle Scalene muscles Needle Placement Carotid artery, internal jugular vein (if visualized medially) In plane (medial to lateral)
Needle Placement In plane (lateral to medial) Visualize local anesthetic spread proximally and distally, separating the two nerves Transversus Abdominis Plane (TAP) Block Patient Positioning Supine, arm extended over head Probe Placement Transverse on the abdomen Anterior axillary line, between iliac crest and costal margin Obtaining Image/Pertinent anatomy Locate the muscle layers (slight movements cephalad or caudad may assist in identifying these layers) Identify the following structures: Subcutaneous tissue External Oblique muscle Internal Oblique muscle Transverse Abdominal muscle Peritoneum Needle Placement In plane (medial to lateral) Visualize local spread between the internal oblique and the transversus planes Interscalene Block Patient Positioning Sitting with HOB 30 degrees with neck turned away from block side Placement Transverse on neck, 3-4 cm cephalad to clavicle, just lateral to SCM Obtaining anatomy Start just cephalad to clavicle at the midclavicular line. Visualize subclavian artery and divisions of the brachial plexus Trace the brachial plexus cephalad, to the level of cricoid cartilage, approximately 2-3cm above clavicle Classic traffic light view between the bellies of the anterior and middle scalene muscles Identify the following structures: C5, C6, C7 nerve roots Sternocleidomastoid, Anterior Scalene, and Middle Scalene muscles Carotid artery, internal jugular vein (if visualized medially)
OSCE%20Regional%20Ultrasound%20Review.docx