Ex3 Positioning Flashcards by Rachel Unknown

Biggest problem with position changes

Hypotension

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What must be checked after head, neck, whole body is moved?

Breath sounds
- also document
if breath sounds in R>L, pull tube back (it is in mainstem)

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Before prone, what should always be checked?

PIP, shape of ETCO2, breath sounds

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Supine - where should focus be on arms?

Olecranon - must be padded

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Supine - how should arms be positioned

Supinated (back of hand down, arm with hand up)

NOT proned

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Physiologic changes with supine position

Decreased FRC (20%), pulm compliance
Gravity increases to zone III
Compression of IVC

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What should never be used in trendelenberg position?

Shoulder brace (d/t brachial plexus injury)

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Who should never be placed in trendelenberg?

Increased ICP patients

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Prone position - head monitoring

Maintain cervical spine in neutral position

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Prone - arm positioning

Avoid extending above shoulders (brachial plexus injury)

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Physiologic changes - lateral decubitus (ventilated, anesthetized patient)

Perfusion - gravity dependent

Ventilation - favors non dependent lung

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What is always going to occur in lateral decubitus position (ventilated patient)?

V/Q mismatch = decreased PaO2

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Awake, spontaneous patient in lateral decubitus

Only change = blood flow/ventilation in dependent lung are greater than non dependent lung
NO V/Q MISMATCH

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Mnemonic for nerve damage in lithotomy position

FOPSS

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FOPSS

Femoral
Obturator 
Peroneal 
Saphenous 
Sciatic

(nerves at risk for damage in lithotomy position)

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F in FOPSS

Femoral nerve: stretched by excessive angulation of thigh

—> FRONT

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O in FOPSS

Obturator Nerve - stretched by excessive flexion of thigh to groin
*** confirm position????

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P in FOPSS

Peroneal (common) nerve: compression of LATERAL aspect of legs at head of fibula against stirrup

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S in FOPSS

Saphenous Nerve - compression of MEDIAL aspect of legs against stirrup supports

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2nd S in FOPSS

Sciatic nerve - stretched by excessive external rotation of leg when placing pt in lithotomy position
(In the BACK)

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Biggest risk of sitting position

VAE (venous air embolism)

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How to counteract risks in sitting

Venodynes, TEDS

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Radial nerve - how is it injured?

Compression against underlying humerus when lateral upper arm is compressed on table

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Result of radial nerve injury

inability to extend wrist, abduct thumb
wrist drop
decreased sensation over dorsal surface of later 3.5 fingers (thumb->half ring finger)

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Cause of ulnar nerve injury

Compression between medial epicondyle of humerus —> sharp edge of bed/head frame

Result of ulnar nerve injury

Sensory loss in 5th digit (pinky) | “Claw hand”

Where would claw hand be seen?

Ulnar nerve injury

Cause of median nerve injury

Indiscriminate probing (fishing) in AC fossa during IV placement

Result of median nerve injury

- loss of sensation of finger tips from thumb to mid-point of ring finger - inability to oppose 1st/5th digits - decreased sensation on palmar surface of lateral 3.5 fingers

Cause of sciatic nerve injury

- sitting: pressure on ischial tuberosity - lithotomy: thigh/nerves externally rotated, knees extended - excessive hip flexion =nerve stretch - IM injection

Result of sciatic nerve injury

- weakness of all muscles below knee/diminished sensation over lateral 1/2 of leg/all of foot - foot drop - pain/numbness of lower leg/thigh/foot

Candy Cane Stirrups cause damage from what?

Lateral thighs hyperflexed

Physiologic changes in Supine - obese/pregnant

compression of IVC

Awake vs anesthetized pt in supine

Awake - SNS can compensate | Blood flow = gravity

Physiologic changes in Supine position

``` Decreased - FRC, pulm compliance Increased - blood flow to Lung ZoneIII Cephaled shift of abd Minimal CVS changes Pressure on occiput ```

If shoulder braces are used, where should they be placed?

NOT near neck (compression of brachial plexus)

Physiologic changes in Trendelenberg Position

Same as supine except --> increased cerebral circulation Increased: CBF, venous pressure Decreased: FRC, pulm compliance

Greatest decline in FRC is in which position?

Trendelenberg

Jack Knife position

prone + kneeling

Physiologic changes in prone position

Increased: ventilation, venous return Decreased: intrathoracic/vena cava/abd pressure

Best for Prone position

1. Jackson Table 2. Wilson Frame 3. 2 padded chest rolls from shoulder --> hips

Ideal face position in prone

face down in doughnut/Mayfield

V/Q in proning

optimal matching

Avoid what in proning?

- pressure on facial nerve/any pendulous soft tissue - extending arms above shoulders - turning head to the side

Turning head to the side in prone position - Risk

paralysis | obstruction of jugular venous/vert. artery flow

Kidney rest position

lateral decub with flexion at iliac crest

Lateral Decub - head injury presents as

Horner's Syndrome -- nerve damage

Lateral Decub - monitor

distal circulation of dependent arm frequently to avoid compression of axillary artery

Best for non-dependent arm in Lateral Decub

Mayo Stand

V/Q effect in Lateral Decubitus Position

V/Q mismatch -- decreased PaO2 | *only in anesthetized/MV patients

Lateral decub - effects on lungs

perfusion favors dependent lung ventilation favors nondependent lung (decreased compliance in dep lung)

Compartment syndrome is most common in which position?

Lithotomy

Increased risk of compartment syndrome if

time > 2-3h Obesity Hypoperfusion

Trendelenberg +Lithotomy position can result in

atelectasis (dec lung volume 20% d/t abd pressure)

Femoral nerve damage can be reduced by

avoiding hip flexion > 90d | excessive angulation of thigh

Femoral nerve damage results in

absent knee jerk, decreased sensation in thigh

Obturator nerve damage can be reduced by

avoiding excessive flexion of thigh | avoiding forceps delivery

Obturator nerve damage results in

unable to adduct leg | decreased sensation in medial thigh

most common nerve damage in lithotomy position

peroneal

Peroneal nerve damage can be reduced by

avoid candy cane stirrups | padding lateral aspect of fibula

Result of peroneal nerve damage

Foot drop, unable to evert foot/dorsal extend toes

How to reduce saphenous nerve damage

pad medial side of knee

result of saphenous nerve damage

decreased sensation of anteromedial leg

how to reduce sciatic nerve damage

avoid excessive external rotation of leg/flex hip, pad butt

result of sciatic nerve damage

weak below knee dec. sensation in lateral leg/all foot foot drop pain/numb in lower leg/thigh, foot

Nerves which damage causes foot drop

Sciatic | Peroneal

Most common nerve injured

ulnar

Nerve injury d/t IV AC attempt, carpal tunnel

Median

Nerve damage results in wrist drop

Radial Nerve

Weak arm function d/t _____ nerve injury

Brachial plexus