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Dr.Kartik Sonawane Verified account @KartikBSonawane
โšก ๐๐€๐‘๐“ ๐‚: ๐…๐ซ๐จ๐ฆ ๐๐ž๐ซ๐ฏ๐ž ๐ƒ๐ž๐ฉ๐จ๐ฅ๐š๐ซ๐ข๐ณ๐š๐ญ๐ข๐จ๐ง ๐ญ๐จ ๐Œ๐ฎ๐ฌ๐œ๐ฅ๐ž ๐“๐ฐ๐ข๐ญ๐œ๐ก - ๐–๐ก๐ฒ ๐“๐ฐ๐ข๐ญ๐œ๐ก ๐ˆ๐ฌ ๐ƒ๐ข๐ฌ๐ญ๐š๐ฅ ๐ข๐Ÿ ๐‚๐ฎ๐ซ๐ซ๐ž๐ง๐ญ ๐ข๐ฌ ๐๐ข๐๐ข๐ซ๐ž๐œ๐ญ๐ข๐จ๐ง๐š๐ฅ #RegionalAnesthesia #PeripheralNerveStimulator #PNSPrinciples #NerveStimulation #NerveDepolarization #ActionPotential #MotorResponse #MuscleTwitch #TipOfTheDay #MyRATips ๐“๐ข๐ฉ ๐จ๐Ÿ ๐ญ๐ก๐ž ๐ƒ๐š๐ฒ : ๐Ÿ”ท ๐Ÿ. ๐๐๐’ ๐ฌ๐ญ๐ข๐ฆ๐ฎ๐ฅ๐š๐ญ๐ž๐ฌ ๐ฅ๐จ๐œ๐š๐ฅ๐ฅ๐ฒ โ–ช๏ธ PNS does not electrify the whole nerve like a wire โ–ช๏ธ The strongest field is near the needle tip โ–ช๏ธ If nearby nerve membrane reaches threshold, action potential starts ๐Ÿ”ท ๐Ÿ. ๐๐ž๐ซ๐ฏ๐ž ๐œ๐จ๐ง๐๐ฎ๐œ๐ญ๐ข๐จ๐ง ๐ข๐ฌ ๐ฉ๐ก๐ฒ๐ฌ๐ข๐จ๐ฅ๐จ๐ ๐ข๐œ๐š๐ฅ โ–ช๏ธ Once action potential starts: ๐Ÿ”ธ Voltage-gated sodium channels open ๐Ÿ”ธ Ionic movement occurs across nerve membrane ๐Ÿ”ธ Depolarization propagates along the nerve โ–ช๏ธ This is not simple electric flow โ–ช๏ธ This is biological nerve conduction ๐Ÿ”ท ๐Ÿ‘. ๐€๐œ๐ญ๐ข๐จ๐ง ๐ฉ๐จ๐ญ๐ž๐ง๐ญ๐ข๐š๐ฅ ๐œ๐š๐ง ๐ญ๐ซ๐š๐ฏ๐ž๐ฅ ๐›๐จ๐ญ๐ก ๐ฐ๐š๐ฒ๐ฌ โ–ช๏ธ From stimulation point, impulse may travel: ๐Ÿ”ธ Distally toward muscle ๐Ÿ”ธ Proximally toward spinal cord ๐Ÿ”ท ๐Ÿ’. ๐–๐ก๐ฒ ๐œ๐จ๐ง๐ญ๐ซ๐š๐œ๐ญ๐ข๐จ๐ง ๐ข๐ฌ ๐๐ข๐ฌ๐ญ๐š๐ฅ โ–ช๏ธ Distal impulse reaches neuromuscular junction โ–ช๏ธ Acetylcholine is released โ–ช๏ธ Muscle end plate activates โ–ช๏ธ Visible twitch occurs ๐Ÿ”ท ๐Ÿ“. ๐–๐ก๐ฒ ๐ฉ๐ซ๐จ๐ฑ๐ข๐ฆ๐š๐ฅ ๐ข๐ฆ๐ฉ๐ฎ๐ฅ๐ฌ๐ž ๐๐จ๐ž๐ฌ ๐ง๐จ๐ญ ๐œ๐ซ๐ž๐š๐ญ๐ž ๐ฉ๐ซ๐จ๐ฑ๐ข๐ฆ๐š๐ฅ ๐ญ๐ฐ๐ข๐ญ๐œ๐ก โ–ช๏ธ Proximal impulse goes toward cell body/spinal cord โ–ช๏ธ There is no neuromuscular junction proximally โ–ช๏ธ No muscle end plate means no visible contraction โ–ช๏ธ So distal twitch is not because proximal current is arrested โ–ช๏ธ Distal twitch occurs because muscle connection is distal ๐Ÿ”ท ๐Ÿ”. ๐‚๐ฅ๐ข๐ง๐ข๐œ๐š๐ฅ ๐ข๐ง๐ญ๐ž๐ซ๐ฉ๐ซ๐ž๐ญ๐š๐ญ๐ข๐จ๐ง โ–ช๏ธ PNS twitch confirms functional motor axon activation โ–ช๏ธ It does not perfectly measure needleโ€“nerve distance โ–ช๏ธ Threshold depends on: ๐Ÿ”ธ Needle position ๐Ÿ”ธ Pulse width ๐Ÿ”ธ Tissue resistance ๐Ÿ”ธ Nerve excitability ๐Ÿ”ธ Neuropathy ๐Ÿ”ธ Local anatomy โœ… ๐Š๐ž๐ฒ ๐“๐š๐ค๐ž๐š๐ฐ๐š๐ฒ ๐Ÿ”ธ PNS starts local depolarization ๐Ÿ”ธ Nerve then conducts physiologically ๐Ÿ”ธ Impulse may travel both ways ๐Ÿ”ธ Twitch is distal because neuromuscular junction is distal โšก PNS starts local depolarization, the impulse travels both ways, but the twitch appears distally because the neuromuscular junction is distal.
KartikBSonawane's tweet photo. โšก ๐๐€๐‘๐“ ๐‚: ๐…๐ซ๐จ๐ฆ ๐๐ž๐ซ๐ฏ๐ž ๐ƒ๐ž๐ฉ๐จ๐ฅ๐š๐ซ๐ข๐ณ๐š๐ญ๐ข๐จ๐ง ๐ญ๐จ ๐Œ๐ฎ๐ฌ๐œ๐ฅ๐ž ๐“๐ฐ๐ข๐ญ๐œ๐ก - ๐–๐ก๐ฒ ๐“๐ฐ๐ข๐ญ๐œ๐ก ๐ˆ๐ฌ ๐ƒ๐ข๐ฌ๐ญ๐š๐ฅ ๐ข๐Ÿ ๐‚๐ฎ๐ซ๐ซ๐ž๐ง๐ญ ๐ข๐ฌ ๐๐ข๐๐ข๐ซ๐ž๐œ๐ญ๐ข๐จ๐ง๐š๐ฅ #RegionalAnesthesia #PeripheralNerveStimulator #PNSPrinciples #NerveStimulation #NerveDepolarization #ActionPotential #MotorResponse #MuscleTwitch #TipOfTheDay #MyRATips ๐“๐ข๐ฉ ๐จ๐Ÿ ๐ญ๐ก๐ž ๐ƒ๐š๐ฒ : ๐Ÿ”ท ๐Ÿ. ๐๐๐’ ๐ฌ๐ญ๐ข๐ฆ๐ฎ๐ฅ๐š๐ญ๐ž๐ฌ ๐ฅ๐จ๐œ๐š๐ฅ๐ฅ๐ฒ โ–ช๏ธ PNS does not electrify the whole nerve like a wire โ–ช๏ธ The strongest field is near the needle tip โ–ช๏ธ If nearby nerve membrane reaches threshold, action potential starts ๐Ÿ”ท ๐Ÿ. ๐๐ž๐ซ๐ฏ๐ž ๐œ๐จ๐ง๐๐ฎ๐œ๐ญ๐ข๐จ๐ง ๐ข๐ฌ ๐ฉ๐ก๐ฒ๐ฌ๐ข๐จ๐ฅ๐จ๐ ๐ข๐œ๐š๐ฅ โ–ช๏ธ Once action potential starts: ๐Ÿ”ธ Voltage-gated sodium channels open ๐Ÿ”ธ Ionic movement occurs across nerve membrane ๐Ÿ”ธ Depolarization propagates along the nerve โ–ช๏ธ This is not simple electric flow โ–ช๏ธ This is biological nerve conduction ๐Ÿ”ท ๐Ÿ‘. ๐€๐œ๐ญ๐ข๐จ๐ง ๐ฉ๐จ๐ญ๐ž๐ง๐ญ๐ข๐š๐ฅ ๐œ๐š๐ง ๐ญ๐ซ๐š๐ฏ๐ž๐ฅ ๐›๐จ๐ญ๐ก ๐ฐ๐š๐ฒ๐ฌ โ–ช๏ธ From stimulation point, impulse may travel: ๐Ÿ”ธ Distally toward muscle ๐Ÿ”ธ Proximally toward spinal cord ๐Ÿ”ท ๐Ÿ’. ๐–๐ก๐ฒ ๐œ๐จ๐ง๐ญ๐ซ๐š๐œ๐ญ๐ข๐จ๐ง ๐ข๐ฌ ๐๐ข๐ฌ๐ญ๐š๐ฅ โ–ช๏ธ Distal impulse reaches neuromuscular junction โ–ช๏ธ Acetylcholine is released โ–ช๏ธ Muscle end plate activates โ–ช๏ธ Visible twitch occurs ๐Ÿ”ท ๐Ÿ“. ๐–๐ก๐ฒ ๐ฉ๐ซ๐จ๐ฑ๐ข๐ฆ๐š๐ฅ ๐ข๐ฆ๐ฉ๐ฎ๐ฅ๐ฌ๐ž ๐๐จ๐ž๐ฌ ๐ง๐จ๐ญ ๐œ๐ซ๐ž๐š๐ญ๐ž ๐ฉ๐ซ๐จ๐ฑ๐ข๐ฆ๐š๐ฅ ๐ญ๐ฐ๐ข๐ญ๐œ๐ก โ–ช๏ธ Proximal impulse goes toward cell body/spinal cord โ–ช๏ธ There is no neuromuscular junction proximally โ–ช๏ธ No muscle end plate means no visible contraction โ–ช๏ธ So distal twitch is not because proximal current is arrested โ–ช๏ธ Distal twitch occurs because muscle connection is distal ๐Ÿ”ท ๐Ÿ”. ๐‚๐ฅ๐ข๐ง๐ข๐œ๐š๐ฅ ๐ข๐ง๐ญ๐ž๐ซ๐ฉ๐ซ๐ž๐ญ๐š๐ญ๐ข๐จ๐ง โ–ช๏ธ PNS twitch confirms functional motor axon activation โ–ช๏ธ It does not perfectly measure needleโ€“nerve distance โ–ช๏ธ Threshold depends on: ๐Ÿ”ธ Needle position ๐Ÿ”ธ Pulse width ๐Ÿ”ธ Tissue resistance ๐Ÿ”ธ Nerve excitability ๐Ÿ”ธ Neuropathy ๐Ÿ”ธ Local anatomy โœ… ๐Š๐ž๐ฒ ๐“๐š๐ค๐ž๐š๐ฐ๐š๐ฒ ๐Ÿ”ธ PNS starts local depolarization ๐Ÿ”ธ Nerve then conducts physiologically ๐Ÿ”ธ Impulse may travel both ways ๐Ÿ”ธ Twitch is distal because neuromuscular junction is distal โšก PNS starts local depolarization, the impulse travels both ways, but the twitch appears distally because the neuromuscular junction is distal.
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Dr.Kartik Sonawane Verified account @KartikBSonawane
โšก ๐๐€๐‘๐“ ๐€: ๐…๐ซ๐จ๐ฆ ๐๐๐’ ๐Œ๐š๐œ๐ก๐ข๐ง๐ž ๐ญ๐จ ๐๐š๐ญ๐ข๐ž๐ง๐ญ ๐“๐ข๐ฌ๐ฌ๐ฎ๐ž : ๐„๐ฅ๐ž๐œ๐ญ๐ซ๐จ๐ง๐ข๐œ ๐‚๐ฎ๐ซ๐ซ๐ž๐ง๐ญ โ†’ ๐ˆ๐จ๐ง๐ข๐œ ๐‚๐ฎ๐ซ๐ซ๐ž๐ง๐ญ #RegionalAnesthesia #PeripheralNerveStimulator #PNSPrinciples #NerveStimulation #ElectronicCurrent #IonicCurrent #ElectricField #NeedleTipCurrent #NerveBlock #TipOfTheDay #MyRATips ๐“๐ข๐ฉ ๐จ๐Ÿ ๐ญ๐ก๐ž ๐ƒ๐š๐ฒ : ๐Ÿ”ท ๐Ÿ. ๐๐๐’ ๐ฆ๐š๐œ๐ก๐ข๐ง๐ž ๐๐จ๐ž๐ฌ ๐ง๐จ๐ญ ๐œ๐ซ๐ž๐š๐ญ๐ž ๐œ๐ก๐š๐ซ๐ ๐ž โ–ช๏ธ It creates an electrical pulse โ–ช๏ธ It generates a potential difference between two electrodes โ–ช๏ธ This potential difference drives current through the circuit ๐Ÿ”ท ๐Ÿ. ๐ˆ๐ง๐ฌ๐ข๐๐ž ๐ฆ๐š๐œ๐ก๐ข๐ง๐ž ๐š๐ง๐ ๐œ๐š๐›๐ฅ๐ž๐ฌ โ–ช๏ธ Current is carried by electrons โ–ช๏ธ Electrons move through metal conductors โ–ช๏ธ This is called electronic current ๐Ÿ”ท ๐Ÿ‘. ๐€๐ญ ๐ญ๐ก๐ž ๐ง๐ž๐ž๐๐ฅ๐ž-๐ญ๐ข๐ฌ๐ฌ๐ฎ๐ž ๐ข๐ง๐ญ๐ž๐ซ๐Ÿ๐š๐œ๐ž โ–ช๏ธ Current does not enter tissue as electrons โ–ช๏ธ Metal conduction changes into tissue conduction โ–ช๏ธ Tissue conducts current mainly through ions ๐Ÿ”ท ๐Ÿ’. ๐ˆ๐ง๐ฌ๐ข๐๐ž ๐ฉ๐š๐ญ๐ข๐ž๐ง๐ญ ๐ญ๐ข๐ฌ๐ฌ๐ฎ๐ž โ–ช๏ธ Charge carriers are mainly: ๐Ÿ”ธ Naโบ ๐Ÿ”ธ Kโบ ๐Ÿ”ธ Clโป ๐Ÿ”ธ Caยฒโบ โ–ช๏ธ This is still electric current โ–ช๏ธ But the carrier is ionic, not electronic ๐Ÿ”ท ๐Ÿ“. ๐„๐ฅ๐ž๐œ๐ญ๐ซ๐ข๐œ ๐Ÿ๐ข๐ž๐ฅ๐ ๐Ÿ๐จ๐ซ๐ฆ๐š๐ญ๐ข๐จ๐ง โ–ช๏ธ The cathode and anode create an electric field in tissue โ–ช๏ธ This field is strongest near the small needle tip โ–ช๏ธ The field influences nearby nerve membrane voltage โœ… ๐Š๐ž๐ฒ ๐“๐š๐ค๐ž๐š๐ฐ๐š๐ฒ ๐Ÿ”ธ In cables: electronic current ๐Ÿ”ธ In tissue: ionic electric current ๐Ÿ”ธ PNS works by transferring an electrical pulse from machine to biological tissue โšกPNS current is ๐„๐‹๐„๐‚๐“๐‘๐Ž๐๐ˆ๐‚ in the machine, ๐ˆ๐Ž๐๐ˆ๐‚ in the patient, & ๐๐‡๐˜๐’๐ˆ๐Ž๐‹๐Ž๐†๐ˆ๐‚ in Nerves.
KartikBSonawane's tweet photo. โšก ๐๐€๐‘๐“ ๐€: ๐…๐ซ๐จ๐ฆ ๐๐๐’ ๐Œ๐š๐œ๐ก๐ข๐ง๐ž ๐ญ๐จ ๐๐š๐ญ๐ข๐ž๐ง๐ญ ๐“๐ข๐ฌ๐ฌ๐ฎ๐ž : ๐„๐ฅ๐ž๐œ๐ญ๐ซ๐จ๐ง๐ข๐œ ๐‚๐ฎ๐ซ๐ซ๐ž๐ง๐ญ โ†’ ๐ˆ๐จ๐ง๐ข๐œ ๐‚๐ฎ๐ซ๐ซ๐ž๐ง๐ญ #RegionalAnesthesia #PeripheralNerveStimulator #PNSPrinciples #NerveStimulation #ElectronicCurrent #IonicCurrent #ElectricField #NeedleTipCurrent #NerveBlock #TipOfTheDay #MyRATips ๐“๐ข๐ฉ ๐จ๐Ÿ ๐ญ๐ก๐ž ๐ƒ๐š๐ฒ : ๐Ÿ”ท ๐Ÿ. ๐๐๐’ ๐ฆ๐š๐œ๐ก๐ข๐ง๐ž ๐๐จ๐ž๐ฌ ๐ง๐จ๐ญ ๐œ๐ซ๐ž๐š๐ญ๐ž ๐œ๐ก๐š๐ซ๐ ๐ž โ–ช๏ธ It creates an electrical pulse โ–ช๏ธ It generates a potential difference between two electrodes โ–ช๏ธ This potential difference drives current through the circuit ๐Ÿ”ท ๐Ÿ. ๐ˆ๐ง๐ฌ๐ข๐๐ž ๐ฆ๐š๐œ๐ก๐ข๐ง๐ž ๐š๐ง๐ ๐œ๐š๐›๐ฅ๐ž๐ฌ โ–ช๏ธ Current is carried by electrons โ–ช๏ธ Electrons move through metal conductors โ–ช๏ธ This is called electronic current ๐Ÿ”ท ๐Ÿ‘. ๐€๐ญ ๐ญ๐ก๐ž ๐ง๐ž๐ž๐๐ฅ๐ž-๐ญ๐ข๐ฌ๐ฌ๐ฎ๐ž ๐ข๐ง๐ญ๐ž๐ซ๐Ÿ๐š๐œ๐ž โ–ช๏ธ Current does not enter tissue as electrons โ–ช๏ธ Metal conduction changes into tissue conduction โ–ช๏ธ Tissue conducts current mainly through ions ๐Ÿ”ท ๐Ÿ’. ๐ˆ๐ง๐ฌ๐ข๐๐ž ๐ฉ๐š๐ญ๐ข๐ž๐ง๐ญ ๐ญ๐ข๐ฌ๐ฌ๐ฎ๐ž โ–ช๏ธ Charge carriers are mainly: ๐Ÿ”ธ Naโบ ๐Ÿ”ธ Kโบ ๐Ÿ”ธ Clโป ๐Ÿ”ธ Caยฒโบ โ–ช๏ธ This is still electric current โ–ช๏ธ But the carrier is ionic, not electronic ๐Ÿ”ท ๐Ÿ“. ๐„๐ฅ๐ž๐œ๐ญ๐ซ๐ข๐œ ๐Ÿ๐ข๐ž๐ฅ๐ ๐Ÿ๐จ๐ซ๐ฆ๐š๐ญ๐ข๐จ๐ง โ–ช๏ธ The cathode and anode create an electric field in tissue โ–ช๏ธ This field is strongest near the small needle tip โ–ช๏ธ The field influences nearby nerve membrane voltage โœ… ๐Š๐ž๐ฒ ๐“๐š๐ค๐ž๐š๐ฐ๐š๐ฒ ๐Ÿ”ธ In cables: electronic current ๐Ÿ”ธ In tissue: ionic electric current ๐Ÿ”ธ PNS works by transferring an electrical pulse from machine to biological tissue โšกPNS current is ๐„๐‹๐„๐‚๐“๐‘๐Ž๐๐ˆ๐‚ in the machine, ๐ˆ๐Ž๐๐ˆ๐‚ in the patient, & ๐๐‡๐˜๐’๐ˆ๐Ž๐‹๐Ž๐†๐ˆ๐‚ in Nerves.
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