Midterm Flashcards
second leading cause of OR law suits?
Nerve injuries (22%)
3 largest reasons of inadequate documentation
- Positioning
- Padding
- Preexisting nerve injuries
most common nerve injuries (and %) (4)
- Ulnar (28%)
- Brachial Plexus (20%)
- Lumbosacral (?)
- Spinal cord (16%)
Risk factors of nerve injuries (5)
- Positioning
- Preexisting conditions (DM, tobacco, hypotension, hypothermia, liver disease, anemia, alcoholism)
- General anesthesia
- Extremes of weight (obese/thin)
- OR >4hrs
Pathophys of nerve injury (4)
- Transection
- compression
- stretch
- kink
(all equals ischemia)
5 nerves of the Brachial Plexus
- Radial
- Ulnar
- Median
- axillary
- musculocutaneous
Order of nerves in arms (medial to distal) and what saying to remember them?
- Roots
- Trunks
- Divisions
- cords
- branches
Randy Travis Drinks Cold Beer
What spinal processes innervate the Brachial plexus
- C5-8
- T1
which 3 nerves reach hand?
- Ulnar
- Radial
- Median
which nerve is responsible for carpel tunnel?
- Median
innervates bottom of hand and nailbeds
- Median
cant grasp if damaged
innervates back of hand
- Radial
cant bend fingers back if damaged
innervates shoulder joint and covers deltoid
- axillary
innervates bicep and skin over bicep and forearm
- musculocutaneous
spinal processes for lumbar plexus
L1-L5
spinal processes for sacral plexus
- L4-L5
- S1-S5
- C0
T4 located at the ?
Nipple line
T6-T7 located at the ?
Xiphoid process
T10 located at the ?
Belly Button
Axillary Roll risk of ?
Brachial plexus compression
tight table strap can damage?
spinal processes for lumbar plexus
Stirrups can damage? (2)
Lateral - Common Peroneal Nerve
Medial - saphenous nerve
Armboard or shoulder braces can damage?
Brachial Plexus
Tourniquets, BP cuffs, firm surface can damage?
Radial Nerve
longer length cases risk of damage what nerve?
Ocular Nerve
Perioperative factors related to nerve damage?
- Longer cases
- General anesthesia
- Hypotensive technique
- Neuromuscular blockade
Respiratory considerations for supine position?
- Decreased FRC and total lung capacity
pressure change in trend position
2 mmHg for every 2.5 cm above/below heart
what receptors compensate for extra volume near heart?
Baroreceptors
neuro considerations for trendelenburg position
- Increased ICP
- Decreased CBF (from cerebral venous congestion)
- Increased Intraocular pressure in glaucoma
lithotomy considerations? (2)
- raise and lower both legs together
- lower legs slowly and together
where to place pulse ox in Lateral position?
dependent side (side of positioning - left lateral = left side)
high risk position for vision loss?
prone
what to maintain for decreased eye nerve damage?
MAP within 20% baseline
positions where air emboli greatest risk
-sitting
-prone
-lateral
(when operative site above level of heart)
positions with risk of compartment syndrome (2)
and at what case length?
- Lateral
- Lithotomy
> 5 hours
what does common peroneal nerve damage manifest as? Also, how common?
Foot drop
most common lower extremity nerve damage
radial nerve injury manifests as?
wrist drop
ulnar nerve damage manifests as?
sensory loss fifth digit and claw hand
what to do if air emboli suspected?
spill saline on field and turn pt left lateral
