E2 - Positioning Flashcards
What is the most common surgical position?
A. Sitting
B. Beach chair
C. Supine
D. Prone
C. Supine
Arm boards must be secure if in use.
What are initial physiological changes to be expected when moving from sitting to supine? Select 3
A. decreased SV
B. increased VR
C. increased SV
D. increased tidal volume
E. decreased VR
F. decreased FRC
B. ↑ Venous return
↑ Preload
C. ↑ SV
↑ CO
↓Tidal volume
F. ↓ FRC
When positioning arms abducted, what should you NOT do?
A. Put arms supine (palms up)
B. Put arm out to the side, > 90 degrees
C. Pad Elbows and secure arm with a Velcro strap
D. Secure padded arm boards to the table and patient’s axilla
B. put arm out to the side, > 90 degrees
*arms should be abducted LESS than 90 degrees *
What is important to remember about arm adduction positioning? select 2.
A. hands and forearm cannot be supine (palms up)
B. pad elbows
C. tuck arms alongside the body
D. arms held along the side of body via draw sheet over the body and under the arm
E. do not tuck arms if surgeon needs to stand on side of pt
B. Elbows are padded
C. Arm tucked alongside the body
Arms held along the side of body via **draw sheet under the body and over the arm **
**May tuck one arm **if surgeon must stand on side of patient
Hand and forearm are supine** (palms up) or neutral position (palms toward body)***
Two specific complications of the supine position include:
A. increased ICP
B. pressure alopecia
C. headache
D. increased facial edema
E. stretch (brachial plexus) injury when neck is extended and head turned away
B. Pressure alopecia
E. Stretch injury when neck is extended and head turned away (brachial plexus)
Others: Backache, Brachial plexus or axillary nerve injury if arms abducted > 90 degrees, Ulnar nerve injury if hand/arm is pronated (palm down)
What position is this patient in?
- Trendelenburg (head down)
What is a consideration with Trendelenburg position? Select 2.
A. Use a non-sliding mattress/pad to prevent the patient from sliding cephalad
B. Avoid using bean bags or shoulder braces
C. Arms should not be abducted
D. There will be a decrease in cardiac output
A. Use a non-sliding mattress/pad to prevent the patient from sliding cephalad
B. Avoid using bean bags or shoulder braces
Also, consider making a mark at the level of the patient’s head on the sheet or pad so you can determine easily if the patient has slid
What are 2 vent/airway considerations with Trendelenburg position? Select 2.
A. increased pulm compliance
B. may need higher pressure in ventilated patients
C. risk of ETT going right mainstem
D. decreased RV
E. increased ICP
F. increased facial edema
B. May need higher pressure in ventilated patients
C. Risk of endobronchial intubation as abdominal contents push the carina cephalad
Also: ↑ CO, ↑ Venous Return from lower extremities
↑ ICP, ↑ IOP, Facial Edema
↑ Intraabdominal Presure
↓ FRC and ↓ Pulmonary Compliance
What position is this patient in?
- Reverse Trendelenburg (head up)
What is a consideration with Reverse Trendelenburg position?
A. use a sliding pad so its easier to move patient’s head up
B. use a footrest or something under feet to prevent pt from sliding
C. brachial plexus injury is common
D. upward displacement of abd contents and diaphragm
B. Use a footrest or something under the feet to prevent the patient from sliding
and Use a non-sliding mattress/pad to prevent the patient from sliding
also … Downward displacement of abdominal contents/ diaphragm (better ventilation)
What is a major risk associated with reverse trendelenburg?
A. possible self-extubation risk
B. increased aspiration risk
C. decreased perfusion to the brain
D. patient could slide off the table
E. risk of hypertensive crisis
C. Risk of Hypotension (↓ Venous Return, Venous pooling) = ↓ Perfusion to the brain!
make sure CBF is adequate by leveling art line to level of TRAGUS to get accurate MAP readings
Name the positions
- Left Picture: Beach Chair Position
- Right Picture: Full Sitting Position
When will the patient be in the Beach chair position?
A. Knee surgeries
B. C sections
C. Shoulder cases
D. Toe amputations
C. Shoulder Cases
Beach chair position will have less severe hip flexion (than sitting) and slight leg flexion.
Describe the set-up of the full sitting position
- Head must be stabilized – taped to special headrest or rigid pins
- Hips are flexed < 90 degrees and knees slightly flexed for balance to reduce stretching of the sciatic nerve
- Feet are supported – prevent sliding
- Compression stockings/wraps to maintain venous return
- Keep at least two finger’s distance between the chin and sternum
Sitting position risks
- Cerebral hypoperfusion and air embolism
- Pneumocephalus- accumulation of air in subdural space, pressure on the intracranial structure
- Quadriplegia and spinal cord infarction- hyperflexion of the neck
- Cerebral ischemia
- Peripheral nerve injuries (Sciatic nerve injury)
Pathophysiological considerations of the sitting position include: (select 2)
A. hydrocephalus
B. hypotension
C. increased ICP
D. decreased cerebral perfusion pressure
E. brachial plexus injury
B. Hypotension d/t ↓ venous return = ↓ MAP = ↓ Cardiac Index
D. ↓ cerebral Perfusion Pressure
and improved ventilation in non-obese patients
What position is the patient in?
- Prone
What position is the patient in?
- Lithotomy
Patient laying supine with legs up in padded or “candy cane” stirrups + Arms tucked or on arm boards
What position is the patient in?
- Lateral Decubitus Position
Patient lying on non-operative (dependent) side and requires anterior and posterior support w/ rolls or bean bags
A patient is supine with the neck extended and the head turned to the right, away from surgical site. Which positioning complication may occur?
- Brachial plexus nerve injury
Shoulder braces used during Trendelenburg increases the risk of compression injury to the _______.
- Brachial plexus
