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Adv Principles A > Exam 1 (part 2) > Flashcards

Exam 1 (part 2) Flashcards

1
Q

when should nerve issues be assessed for?

A

Preop and post op

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2
Q

what is the most common position for shoulder surgery?

A

beach chair
**lat decubitus less common

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3
Q

safely positioning patients is the responsibility of ______ providers

A

All

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4
Q

what are the cardiac changes seen with beach chair

A

lower extremity blood pooling=decreased central blood volume–>decreased CO and BP; HR and SVR rise to compensate

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5
Q

what are the respiratory changes seen in beach chair?

A

increased FRC and lung volumes

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6
Q

what are the neuro changes seen in beach chair?

A

decreased CBF

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7
Q

what is a serious complication seen in beach chair, prone, and reverse T?

A

Venous air embolism

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8
Q

how is a VAE prevented?

A

keeping venous pressure above 0 at the surgical site to decrease the risk of air intake into the venous system

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9
Q

what % of the general population has a patent foramen ovale (PVO)?

A

20-30%

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10
Q

what happens if air enters the right ventricle and then the pulmonary artery?

A

pulmonary edema and reflex bronchoconstriction

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11
Q

what are 6 steps to help treat/prevent worsening from a VAE?

A

–tell surgeon to irrigate and apply occlusive dressing
–discontinue N2O
–bilateral jugular vein compression
place patient in a head down position to trap air in the R atrium
–withdrawal air through a R side catheter
–anticipate CV collapse

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12
Q

where is an US probe placed to diagnose a VAE in a sitting patient?

A

over the right atrium
(2nd-3rd ICS right of the sternum)

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13
Q

what is the most sensitive non-invasive diagnostic for VAE?

A

doppler ulktrasound

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14
Q

what is the most definitive diagnostic tool for VAE?

A

TEE

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15
Q

what is the characteristic sound of a VAE?

A

mill wheel murmur

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16
Q

what standard monitoring tool can be used to determine a decrease in lung perfusion?

A

decrease in etCO2

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17
Q

what is the name of the head rest used in beach chair?

A

allen head rest

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18
Q

which 3 regional blocks are common for shoulder surgery according to lecture?

A

brachial plexus, interscalene, supraclavicular

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19
Q

what are 3 possible injuries to the eyes in beach chair?

A

corneal abrasion
ischemic optic neuropathy
retinal ischemia
**last 2 are d/t decreased perfusion

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20
Q

how many mmHg difference for each cm above/below where blood pressure is taken?

A

0/77 mmHg/cm

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21
Q

what is the bezold-jarisch reflex?

A

cardiac inhibitory reflex resulting from venous pooling (decreased preload) and hypercontractile ventricle (decreased intraventricular volume)—>hypotension and bradycardia

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22
Q

what are the 3 symptoms of horner syndrome?

A

ptosis
miosis
anhydrosis
**happens on the same side of B plexus injury

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23
Q

what are 4 potential complications of brachial plexus block?

A

phrenic nerve paralysis
horner syndrome
dysphagia
hoarseness

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24
Q

2 common positions for elbow surgery?

A

supine or lateral decubitis

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25
Q

what are the 3 regional blocks good for elbow surgery

A

brachial plexus
infraclavicular
axillary

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26
Q

what are 2 cardiac changes seen in lateral decubitus?

A

–CO remains unchanged unless there is an obstruction (kidney rest)
–arterial BP may fall d/t decreased vascular resistance (more common in R than L decubitis)

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27
Q

what are respiratory changes seen in lateral decubitus pts who are ventilated?

A

–decreased ventilation and increased perfusion (gravity) to dependent lung (increased V/Q mismatch)
–nondependent lung overventilated
**worsens with paralysis or open chest

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28
Q

what are respiratory changes seen in lateral decubitus pts who are spontaneously breathing?

A

increased ventilation of dependent lung (no V/Q mismatch)

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29
Q

axillary rolls are placed ____ in lateral decubitus to prevent neurovascular compression

A

caudad

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30
Q

axillary rolls displace the head of the ____ against the _____. this leads to which 2 types of nerve injury?

A

–humerus, brachial plexus
–stretch and compression

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31
Q

how do you assess NV status to the dependent arm while in surgery?

A

can place pulse ox probe or check radial artery pulse periodically

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32
Q

what is the allen arm rest used for?

A

to rest the upper arm in lateral decubitus. can also just use pillows

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33
Q

if using a tourniquet for elbow surgery, which nerve could also benefit from a regional block?

A

musculocutaneous

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34
Q

what helps greatly with pain in the post op elbow/forearm/hand population?

A

immobilization

35
Q

for forearm/hand procedures, what position is patient in?

A

supine arms out

36
Q

hip fractures are generally considered _______ cases?

A

emergent

37
Q

what is the % mortality in the initial hospitalization in hip fracture pts?

A

10%

38
Q

gastric motility ____ when trauma occurs

A

stops/slows significantly

39
Q

what is the positioning for hip fracture surgery?

A

supine on fracture table

40
Q

what are 4 benefits to using neuraxial anesthesia for hip fracture?

A

–decreased DVT and 1 month mortality
–shorter length of hospital stay
–lower delirium incidence
–improved post-op pain control

41
Q

what are 3 potentially life threatening complications of total hip arthroplasty?

A

bone cement implantation syndrome
intra/post-op hemorrhage
venous thromboembolism

42
Q

what is the positioning for total hip?

A

lateral decubitus–operative side up

43
Q

what are the 2 parts that make up a hip replacement part? lol

A

acetabular and femoral parts

44
Q

what are 3 benefits to neuraxial for total hip?

A

decreased EBL
decreased DVT/PE incidence
decreased post op delirium incidence

45
Q

what is the cement used for total hip called?

A

PMMA or MMA
polymethylmethacrylate

46
Q

what can happen when cement is applied in total hip?

A

immobilization of fat, bone marrow or cement due to pressure exceeding 500 mmHg in the intramedullary space

47
Q

PMMA releases:

A

heat

48
Q

what 2 things result from systemic absorption of PMMA?

A

vasodilation and decreased SVR

49
Q

what 3 things result from PMMA application?

A

platelet aggregation
mircothrombus in the lungs
CV instability

50
Q

what are 5 ways to prevent bone cement implantation syndrome?

A

–minimize hypotension/hypovolemia
–maximize FiO2
–vent hole in femur
–lavage femoral shaft
–avoid bone cement use if possible

51
Q

what is the treatment for bone cement implantation syndrome?

A

increased FiO2, maintain euvolemia, manage hypotension with vasopressors

52
Q

what is the positioning for hip arthroscopy?

A

supine with weighted traction

53
Q

what are the 3 cardiac changes seen in supine with weighted traction?

A

–equalization of pressures throughout arteries
–increased R sided filling and CO
–decreased HR and PVR

54
Q

what are the 4 respiratory changes seen in supine with weighted traction?

A

–increased perfusion to posterior lungs
–diaphragm pushed cephalad
–FRC decreases and may fall below closing volume in older pts
–all things exacerbated by pregnancy/obesity/ascites

55
Q

most common post-op peripheral neuropathy:

A

ulnar nerve

56
Q

what are the 2 major sites of injury for the ulnar nerve?

A

condylar groove and cubital tunnel
**these are where the nerve is most shallow

57
Q

what 2 structures form the condylar groove?

A

medial epicondyle of humerus and olecranon process of ulna

58
Q

is muscle relaxation required for hip arthroscopy?

A

yes

59
Q

which type of hip injury requires a closed reduction?

A

dislocation

60
Q

what is the typical anesthetic for a closed hip reduction?

A

conscious sedation (ex. ketamine and prop)

61
Q

are hip dislocations painful after closed reduction?

A

no

62
Q

what is the positioning for knee arthroscopy?

A

supine with knee flexed

63
Q

is a tourniquet used in knee arthroscopy?

A

sometimes

64
Q

what is the positioning for total knee?

A

supine

65
Q

what is the preferred anesthetic for total knee?

A

neuraxial–>decreased 30 day mortality, decreased infection

66
Q

what 2 nerve blocks are used for total knee?

A

femoral and sciatic

67
Q

how do you assess if the peroneal nerve is intact?

A

dorsiflexion of foot

68
Q

for a total knee, blood loss begins:

A

when the tourniquet is deflated and continues for 24 hours

69
Q

what are the 4 artificial components of a total knee?

A

tibial
femoral
patellar
plastic spacer

70
Q

what are 2 common ways to manage pain post op total knee?

A

indwelling epidural catheter or continuous peripheral nerve block

71
Q

traffic in the OR decreases the desired _____ flow of air

A

laminar

72
Q

what 3 things can contribute to surgical wound infection?

A

poor glucose control perioperatively
post-op hypoxia
post-op hypothermia

73
Q

how much ancef for <70 kg?
70-120 kg?
>120 kg?

A

1G
2G
3G

74
Q

what are 2 benefits to neuraxial in amputations?

A

decreased delirium
decreased phantom pain

75
Q

phantom pain onsets within a few ____ of amputation

A

days

76
Q

3 triggers for phantom pain?

A

weather changes
emotional stress
pressure on remaining area

77
Q

what are 5 potential causes of phantom pain?

A

–remapping on nerve signals
–damaged nerve endings
–scar tissue
–physical memory
–pain prior to amputation

78
Q

4 non-Rx treatments for phantom pain

A

biofeedback
relaxation
massage
TENS unit

79
Q

3 Rx treatments for phantom pain

A

neuroleptics
antidepressants
sodium channel blockers

80
Q

what are 2 positions common for achilles surgery?

A

lateral or prone

81
Q

position for ankle/foot surgeries (other than achilles)?

A

supine

82
Q

5 nerves that contribute to regional block for ankle

A
  1. posterior tibial nerve
  2. saphenous nerve
  3. deep peroneal
  4. superficial peroneal
  5. sural nerve
83
Q

what do these nerves serve as sensory for?
1. posterior tibial nerve
2. saphenous nerve
3. deep peroneal
4. superficial peroneal
5. sural nerve

A
  1. plantar surface
  2. medial malleolus
  3. space b/w big & 2nd toe
  4. dorsum of foot, 2nd-5th toes
  5. lateral foot, lateral 5th toe
84
Q
A

Adv Principles A (5 decks)

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