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Positioning > Apex- Positioning > Flashcards

Apex- Positioning Flashcards

1
Q

see image

A

Sitting and flexed lateral

(positions that decrease preload)

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2
Q

Attenuate = enhance or reduce

A

REDUCE

  • this word will be the death of me so im just gonna start throwing it in randomly
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3
Q

Trendelenberg and lithotomy shift the frank-starling curve to the (left/right)

A

right- increased preload

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4
Q

Prone- frank starling curve shifts to left or right

A

left - blood shifts away from central circulation/venous pooling

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5
Q

hemodynamic effect of flexed lateral position

A
  • shifts franks curve to the left
  • decreased preload
  • venous pooling in legs
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6
Q

The risk of cerebral hypoperfusion is increased when the brain is higher than the heart; where should you transduce your aline

A

at the external auditory meatus

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7
Q

Compared to the awake, spontaneously breathing patient, the anesthetized patient who is spontaneously breathing as an:

increase/decrease in the following:

tidal volume

FRC

closing volume

A

decreased: Vt & FRC

increased closing volume

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8
Q

Why does trendlendberg increase the risk of endobronchial intubation

A

bc all the abdominal contents shift cephalad which pushes the diaphragm towards the ETT

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9
Q

T/F- shoulder brances increase the risk of brachial plexus injury

A

true

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10
Q

2 types of injury that can occur to the brachial plexus

A

1. stretch injury

  • brachial plexus is fixed at the cervical vertebrae and the axillary fascia.
  • risk of stretch injury is highest when the arms are ABducted > 90 degrees and the head is rotated to the other side

2. compression injury

  • compression as it passes between the clavical and first rib (shoulder braces)
  • or by external force (improperly placed ax roll)
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11
Q

Where is the brachial plexus anatomically fixed (2 locations)

A

cerbical vertebrae and axillary fascia

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12
Q

when is the risk of brachial plexus stretch injury the highest?

A

when arms ar abducted > 90 degrees and head is rotated to the other side

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13
Q

shoulder braces cause what kind of nerve injury

A

brachial plexus (compression)

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14
Q

Prone position considerations that should be looked at to decrease risk of brachial plexus injury (2)

A
  1. don’t let shoulders sag forward
  2. arms shouldn’t be extended over the head (keep shoulders and elbows at 90 degrees or less)
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15
Q

When interviewing a patient preop who will be in a prone position, what is a good assessment to evaluate for potential thoracic outlet syndrome

A

ask them to clasp their hands behind their head; if + pain, tuck the arms

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16
Q

in lateral decub; the downside thigh and knee are flexed; why should there be padding between the weight of the leg and the table? what nerve is compromised?

A

common peroneal nerve

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17
Q

In lateral decub, a retaining strap should NOT be directly over what

A

the head of the femur

  • it should be across the hip and fixed under the OR table
  • between the ilac crest and head of femur
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18
Q

Pt is unable to ubduct his fifth digit aafter a prolonged stay in the ICU. Which nerve sustained an injury?

A. Ulnar

B. Median

C. Radial

D. Long throacic

A

A. Ulnar

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19
Q

What is the most commonly injured peripheral nerve?

A

Ulnar nerve

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20
Q

Ulnar nerve injury can present in what 3 ways

A
  1. impaired sensation to the 4th and 5th digits
  2. inability to ABduct or oppose the pinky finger
  3. claw hand (chronic injury/muscular atrophy)
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21
Q

5 risk factors for ulnar injury

A
  1. poor padding/positioning
  2. males (esp > 50yo)
  3. pre-exisiting ulnar neuropathy
  4. extremes of body habitus (very thin or obese)
  5. prolonged hospitalization/bedrest
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22
Q

claw hand signifies what injury

A

chronic ulnar (muscular atrophy)

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23
Q

What nerve injury can result from external compression from an excessively tight arm strap on the forearm

A

Ulnar

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24
Q

T/F- elbow extension increases risk for ulnar nerve injury

A

false- flexion

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25
Q

Most cases of ulnar neuropathy don’t present until > ____ hrs after surgery

A

24hrs

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26
Q

Hand positioning when arms are abducted or tucked has to deal with protecting the patient from which kind of nerve injury

A

ulnar

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27
Q

What position(s) can the hands be in if the arms are abducted

what should be avoided?

A

yes: supinated or thumbs up

NO PALMS DOWN

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28
Q

What way should the hands face when arms are tucked at side

A

with thumbs up

(supinate and pronated hans = bad)

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29
Q

what nerve injury

A

ulnar

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30
Q

T/F- sensory deficits are more common and less serious and tend to resolve on their own

A

True- within 5 days or less

*get neuro consult if perisists more than 5 days

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31
Q

Which nerve is MOST likely to be injured following a traumatic IV insertion in the antecubital space?

A. Ulnar

B. Radial

C. Median

D. Axillary

A

C. Median

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32
Q

What nerve injury is associated with decreased sensation over the palmar surface of the thumb, index finger, middle finger, and lateral aspect of the ring finger

A

median nerve

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33
Q

What nerve injury presents as an inability to oppose the thumb

A

median nerve

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34
Q

What nerve is affected with carpal tunnel syndrome?

A

Median nerve

(only nerve that passes through the carpal tunnel)

35
Q

What nerve is injured with elbow hyperextension

A

median nerve

36
Q

T/F- excessive BP cuff cycling can cause median nerve injury

A

False - RADIAL

37
Q

Which nerve is MOST likley to be injured by an IV pole that presses agaisnt the dorsolateral aspect of the humerous?

A. Median

B. Radial

C. Ulnar

D. Axillary

A

Radial

38
Q

Bone in the upper arm

A

Humerous

(just incase i forget- LOL)

39
Q

Bone in the lower arm

A

Radius

(just incase I forget LOL)

40
Q
A
41
Q

What nerve injury can present from a upper extremity tourniquet?

A

Radial

42
Q

What nerve injury can present from sheets being too tight when arms are tucked?

A

Radial

43
Q

Which nerve injury presents with wrist drop?

A

Radial nerve injury

44
Q

which nerve injury presents as a winged scapula

A

long throacic nerve injury

45
Q

which nerve injury presents with dull shoulder pain

A

suprascapular nerve injury

46
Q

What nerve passes along the spiral groove at the lateral aspect of the humerous (about 3 fingerbredths above the lateral epicondyle).

A

The radial nerve

47
Q

What type of nerve injury

A

Radial nerve injury (wrist drop)

-IV pole, BP cuff, tourniquette, sheets too tight when tucked

48
Q

What nerve injury is this from

A

Long Thoracic

(SALT) - Serratus Anterior Long Thoracic

49
Q

3 eitilogies of long thoracic nerve injury

A

lateral position, trauma, pre-existing neuropathy

50
Q

The long throacic nerve arises from _______ and innervates the ______

A

C5-C7

serratus anterior muscle

  • (SALT)
  • serratus anterious/long thoracic
  • dorsal protrusion of the scapula/winged scapula
51
Q

What nerve is anchored between the C-spine and the suprascapular notch?

A

Suprascapular nerve

52
Q

What injury presents from ventral circumduction of the depedent shoulder in the lateral decub position

-what can diminish this risk?

A

stretch injury to the suprascapular nerve

  • pt rolls onto the depedent arm
  • ax roll can diminish this risk
53
Q
A
54
Q

A Patient develped foot drop following a vaginal hysterectomy. She was positioned in candycane stirrups. Which nerve was injured?

A. Common peroneal

B. Obturator

C. Saphenous

D. Femoral

A

A. common peroneal

55
Q

which nerve injury presents with the inability to ADDuct the leg

A

obturator

56
Q

Flexion of the high towards the groin, excessive traction during abdominal surgery, and forceps delivery can all injury what nerve

A

obturator

57
Q

what kind of nerve injury can present from excessive traction during lower abdominal surgery?

How would it present (3)

A

Femoral

  1. impaired knee extension
  2. impaired hip flexion
  3. decreased sensation over the anteriomedial aspect of leg
58
Q

Which two nerve injurys can resutl in reduced sensation over the anteromedial aspect of the leg?

A

Femoral and Saphenous

59
Q

what nerve injury can present from external pressure applied to the medial aspect of the leg

A

saphenous injury

60
Q

What is the nerve injury common in lithotomy position? (3)

A
  1. Common peroneal nerve injury
    • external pressure at the FIBULAR head
    • foot drop, cant evert foot, cant extend toes dorsally
  2. Sciatic
  • ​excessive HIP FLEXION and extenral rotation
  • foot drop
  1. Saphenous
  • extenral pressure at teh MEDIAL/TIBIAL aspect
  • decreased sensation over the anteromedial aspect of the leg
61
Q

What nerve injury results from external pressure at the level of the fibular head?

A

Common peroneal injury (lithotomy)

62
Q

Pt presents with foot drop, what nerve was injured (2 possiblities - how to differentiate)

A

1. Common Peroneal

  • Foot drop + inability to evert the foot

2. Sciatic

  • Foot drop
63
Q

What nerve injury presents if the nerve is compressed agaisnt a perineal post on an orthopedic fracture table?

A

-Pudendal injury

(loss of penile sensation)

64
Q

which nerve injury presents wtih loss of penile sensation

A

pudendal injury

65
Q

Leaving the patient with leg’s crossed during surgery increases the risk of _______ nerve injury in the top leg and __________injury in the bottom leg

A

sural nerve injury - top leg

peroneal injury - bottom leg

  • foot drop
  • can’t evert foot
  • external pressure on the fibular head
66
Q

T/F- the saphenous vein resides near the tibia

A

true

67
Q
A
68
Q

identify these structures

A

Top bone = femor

small skinny bone = fibula (pointing to fibular head)

common peronal nerve

bigger lower bone = tibia

69
Q

What nerve injury can occur from sitting with legs straight

A

sciatic

(foot drop)

-pad butt, avoid external rotation of hips, flex table at knees

70
Q

Nerve injury that results with decreased sensation over the MEDIAL aspect of the thigh

A

obturator

(femoral = anterior thigh)

71
Q

Which complications are MOST commonly seen with the sitting position? (2)

  • Tracehobronchial compression
  • midcervical tetraplegia
  • lower extremity compartment syndrome
  • paradoxical air embolism
A

-midcervical tetraplegia & paradoxical air embolism

72
Q

What is midcervical tetraplegia caused by?

-what position is this most concerning in

A

hyperflexion of the neck (chin to chest)

-sitting

(but can also occur in patients who underwent tracheal resection (have to have chin to chest for a while until it heals )

73
Q

Compartment syndrome is most commonly seen in what position?

What’s the treatment

A

lithotomy

-fasciotomy

74
Q

Which is better to preserve normal pulmonary mechanics:

Wilson frame and chest rolls or the jackson table

A

jackson stable

75
Q

Why do we use the prone position for patients with ARDS

A

it provides optimal V/Q matching

-maybe one day ill fucking understand this

76
Q

In the patient with a mediastinal mass, what 3 things can worsen tracheobronchial compression (airway collapse):

A
  1. supine position
  2. induction of general anesthesia
  3. loss of spontaneous ventilation/need for positive pressure ventilation)
77
Q

When anesthetizing the patient with an anterior medastinal mass, what 2 things should you do?

What do you do if the airway collapses?

A
  • maintain spontaneous respirations and use a reinforced ETT
  • if you lose the airway, position laterally or prone
78
Q

Who is at increased risk for LE comparment syndrome while in lithotomy?

A
  • surgical time > 2-3 horus
  • increased BMI
  • decreased tissue oxygenation (hypotension)
79
Q

In what instances would a venous air emboli cause RV strain vs stroke?

A

RV strain if normal vasculature (gets lodged in pulm vasculature > increased dead space > increased RV strain)

Stroke if +PFO (VAE > PFO > Left > circ > brain)

80
Q

When in the sitting position, you shouldbe able to place at least ____ fingers in-between the chin and chest - why?

A

2 - to avoid hyperflexion of the neck which could lead to midcervical tetraplegia

81
Q

When you place the patient in prone position, your primary objective is to minimize pressure on what 2 things and why

A

Abodmen and vena cava

  • to improve pulmonary mechanics
  • improve venous return
  • decrease venous pressure
82
Q

What action can help improve the comfort in a supine patient with a hx of back pain?

A

placing a small pad under the lumbar spine to preserve lordosis

83
Q

A patient who is unable to ADDuct her right leg following a difficult forcepts delivery MOST likely sufferered an injury to which nerve?

  • Sciatic
  • Obturator
  • Femoral
  • Lateral femoral cutaenous
A

-Obturator

84
Q

Which surgical position increases the risk of suprascapular nerve injury?

  • Lateral decub
  • Trendlenburg
  • Reverse T
  • Prone
A

Lateral decub

(ventral circumduction of the depedent shoulder)

Positioning (2 decks)

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