Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Intro to Anesthesia > 3) Positioning > Flashcards

3) Positioning Flashcards

1
Q

Supine position

A
  • HD reserved
  • resp: abd contents cephalad
  • PNI: brachial plexus/ ulnar
  • equipment: arm boards/safety straps
  • lumbar support
  • SCD boots
  • easy access to airway/IVs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Trendelenburg

A
  • HD: cerebral vascular congestion (no glaucoma/ TBI)
  • resp: abd contents cephalad (pressure controlled vent)
  • PNI: brachial plexus, ulnar
  • equipment: non skid pads, arm boards, safety strap
  • facial, laryngeal edema (careful IVF)
  • high risk aspiration (consider NGT)
  • high risk ETT migration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Reverse Trendelenberg

A
  • HD: venous pooling, venous stasis, cerebral hypoperfusion, transducer at circle of Willis
  • resp: preserved
  • PNI: brachial plexus, ulnar
  • equipment: safety straps, non ski pads, foot brackets
  • when resuming supine, careful for rebound HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lithotomy

A

-HD: increase preload, CVP, C.O
-resp: decreased FRC, abd contents move cephalad
PNI: brachial plexus, ulnar, common peroneal, common popliteal, sciatic, observatory, lateral femoral cutaneous
-equipment: arm boards, safety straps, stirrups (candy cane, knee crutch, boot)
- pay strict attention to fingers
- raise legs simultaneously
- frequent repositioning
- avoid excess hip flexion/extension and excessive abduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Compartment syndrome

A
  • can occur in Lithotomy and lateral decub
  • occurs when there is limb ischemia, edema, rhabdomyolysis, edema, etc.
  • occurs when procedure >2-3 hours
  • treatment is a fasciotomy
  • high risk is hypotension and vascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lateral decubitus

A
  • HD reserved
  • resp: V/Q
  • PNI: brachial plexus, ulnar, common peroneal, saphenous
  • equipment: arm boards, safety straps, pillows, egg crates, axilla roll
  • pay strict attention to dependent eye, face for swelling
  • frequent suction of airway
  • axilla roll placed distal to axilla fascia
  • NIBP and SpO2 on dependent arm to monitor ischemia
  • pad lumbar spine
  • bend dependent leg and put pillows between bony prominences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prone

A
  • HD: venous pooling SCD boots; IVC/aorta compressed by abd contents, IOVL
  • resp: preserved
  • PNI: brachial plexus, ulnar
  • equipment: safety straps, arm boards, Allen, jackson frame, mirror, horseshoe adapter, mayfield ridge pins
  • intubated and IVs on stretcher, careful EKG placement
  • ETT placement upon position change
  • reposition neck/head frequently to facilitate venous drainage
  • eye care
  • IOVL caused by hypotension, anemia, loss, (increased crystalloid use)
  • monitor genitalia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Supine position complications

A
  • pressure alopecia
  • aortocaval syndrome
  • pressure injuries to sacram
  • back ache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define Lithotomy position

A

Hips flexed: 80-110 degrees
Hips abducted: 30-45 degrees
Legs parallel with torso

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

V/Q

A

Awake/SV: dependent = higher perfusion + ventilation dependent lung
Anesthetized/SV = better perfusion dependent; better ventilation upper lung
Anesthetized/MV = higher perfusion dependent, higher ventilation upper lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Advantages of sitting position

A
  • superior access to airway
  • better ventilation
  • less blood loss in the operative field
  • reduced facial swelling
  • good access to shoulder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risks Sitting

A
  • cervical spine infarct
  • VAE
  • quadrapeligia
  • HD instability
  • tongue swelling
  • PNIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sitting Position

A
  • decreased venous return, venous pooling, decrease CPP; transducer to circle of Willis; incremental position change, pressors, Lower anesthestetic depth to support BP
  • resp: preserved
  • PNI: brachial plexus, ulnar,
  • equipment: safety straps
  • keep head/neck neutral to avoid spinal ischemia; avoid flexion of neck at least 2 fingerbreadths
  • monitor VAE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

VAE

A
  • occurs drural sinuses, surgical procedures above heart, CVC insertion
  • issues associated with: volume of air (3-5cc/kg) and rate of entrapment
  • creates complete RV outflow obstruction
  • put in left lateral decub and trendelenburg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Brachial Plexus Injury

A
  • located between cervical spine and axillary fascia
  • stretching injury: abduct >90 degrees, shoulder not flush with chest, neck turned to side, thoracic outlet syndrome prone
  • compression: axilla roll, cardiac retractors, shoulder brace
  • deficit: numbness paraesthesia pain in entire arm, inability to mobilize arm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ulnar Nerve

A
  • medial side of arm in between olecranon and medial epicondyle
  • stretching during flexion of arm and during extension can cause dislocation over the medial epicondyle
  • compression is pronated hands
  • deficit: pain/numbness in 4/5 digit, inability to grip, inability to abduct pinky, claw hand 48-72 hours
17
Q

Radial Nerve

A
  • sits on lateral side of numerous
  • injury occurs with lateral compression from IV pole, continuous NIBP, mismatched arm board, screen, retractor
  • deficit includes: Saturday night palsy, inability to extend arm, inability to extend hand, pain and numbness in lateral arm and hand
18
Q

Common peroneal nerve

A
  • branch of sciatic; runs lateral side of leg
  • injury from lateral compression from: candy cane stirrup, or lateral side lying position
  • deficit: foot drop, inability to evert foot, inability to extend the toes dorsally
  • pad lateral aspect of leg, reposition frequently, use boots instead of candy cane stirrups
19
Q

Sciatic nerve

A
  • runs over the sciatic notch and neck of femor
  • injury from hyper flexion of hip, hyper extension of knee while stretching, and excessive external rotation of hip
  • Deficit: foot drop, pain and numbness below the level of the knee, numbness in lateral calf
20
Q

Saphenous vein

A
  • runs medial aspect of leg
  • injury often from medial compression from a support in Lithotomy position or from compression during lateral decubitus position
  • deficit: results in paresthesia in medial and anteromedial aspect of leg
  • reposition and pad securely
21
Q

Femoral nerve injury

A
  • located lumbar spine runs through pelvic brim
  • injury with compression at pelvic brim, excessive angulation of thigh/ excessive rotation of hips
  • results in loss of flexion of hip and extension of knee; decreased sensation over superior thigh

Intro to Anesthesia (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions