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APEX-Miscellaneous > MISC-positioning & nerve injury > Flashcards

MISC-positioning & nerve injury Flashcards

1
Q

how does the T-burg position affect a pt position on the Frank-Starling curve

A

They shift right

If a pt has myocardial dysfunction, it can shift the too far right and affect CO

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2
Q

How does the sitting position affect cerebral perfusion pressure

A

If the head is higher than the heart, the CPP is lower

For every 20 cm above the heart MAP drops 15 mmHg

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3
Q

How much does MAP decrease in the brain with sitting position

A

It decreases by 0.75 mmHg for each cm change in height between the heart and reference point (head)

0.75 mmHg per 1 cm

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4
Q

What 4 body positions are associated with a higher incidence of hemodynamic instability under GA

A
  1. reverse T-burg
  2. sitting
  3. flexed lateral
  4. prone
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5
Q

How does anesthesia affect the following lung volumes or capacities
Tidal volume=
FRC=
Closing volume=

A

Tidal volume= DECREASED
FRC= DECREASED
Closing volume= INCREASED

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6
Q

How is the diaphragm affected with T-burg vs reverse t-burg positioning

A 
t-burg = moves cephalad
reverse = moves caudad
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7
Q 
How are the following physiologic measures affected by t-burg positioning:
pulm compliance= 
PIP = 
total lung vol = 
FRC =
A

pulm compliance= decreased
PIP = increased
total lung vol = decreased
FRC = decreased

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8
Q 
How are the following physiologic measures affected by reverse t-burg positioning:
pulm compliance= 
PIP = 
total lung vol = 
FRC =
A

pulm compliance= increased
PIP = decreased
total lung vol = increased
FRC = increased

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9
Q 
How are the following ventilatory parameters altered in the dependent lung region:
alveolar ventilation=
alveolar compliance=
PACO2 =
PAO2 =
V/Q=
A 
alveolar ventilation= increased
alveolar compliance= increased
PACO2 = increased
PAO2 = decreased
V/Q= decreased (shunt)
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10
Q 
How are the following ventilatory parameters altered in the NON-dependent lung region:
alveolar ventilation=
alveolar compliance=
PACO2 =
PAO2 =
V/Q =
A 
alveolar ventilation= decreased
alveolar compliance= decreased
PACO2 = decreased
PAO2 = increased
V/Q = increased (dead space)
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11
Q 
How are the following pulmonary perfusion parameters altered in the dependent lung region:
Blood flow=
Vascular pressure=
vascular resistance=
V/Q=
A

Blood flow= increased
Vascular pressure= increased
vascular resistance= decreased
V/Q= decreased (shunt, zone 3)

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12
Q 
How are the following pulmonary perfusion parameters altered in the NON-dependent lung region:
Blood flow=
Vascular pressure=
vascular resistance=
V/Q=
A

Blood flow= decreased
Vascular pressure= decreased
vascular resistance= increased
V/Q= increased (deadspace, zone 1)

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13
Q

How does positioning of the neck affect ETT tip position

A

flex = ETT tip towards carina (risk of endobronchial intubation)

extension = ETT tip towards VC (risk of extubation)

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14
Q

How does positioning of the carina affect ETT tip position

A

T-burg position can shift carina cephalad

-increases risk of endobronchial intubation

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15
Q

What 2 positioning measures of the head and body can increase the risk of endobronchial intubation

A
  1. flexion of the neck

2. t-burg positioning

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16
Q

3 positioning factors that can increase airway edema

A
  1. prone/t-burg increase hydrostatic pressure
  2. neck flexion impairs venous drainage
  3. excess airway equipment impairs lymphatic drainage
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17
Q

When concerned about airway patency following extubation, what can be done to assess for readiness

A

perform leak test to assess air movement around the ETT

DL to visually inspect larynx

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18
Q

When positioning UE, what decreases risk of stretch injury of the brachial plexus

A
  1. ABduction of arms <90*

2. NOT rotating the head away from either side

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19
Q

What 2 positioning measure increase risk for brachial plexus compression injury

A
  1. shoulder compression

2. axillary roll in the axilla (not under chest)

20
Q

How does arm abduction >90* increase risk of brachial plexus injury

A

It increases stretching of the brachial plexus around the head of the numerus

21
Q

How does head rotation increase the risk of brachial plexus injury

A

Rotation of head can cause stretching injury on the contralateral side

22
Q

How should shoulder braces be positioned to decrease risk of brachial plexus injury

A

placed at DISTAL end of each clavicle over the acromion

23
Q

How should legs be positioned in the lateral decubitus position to prevent nerve injury

A
  1. down leg is flexed and padded (prevent common perineal n. injury)
  2. up leg is extended and pillows placed between legs
24
Q

Where are safety straps placed in the lateral decubitus position

A
  1. between iliac crest and femur head (NOT over the femur head)
  2. over the thorax or shoulders
25
Q

What are 4 causes of radial nerve injury

A
  1. external compression by an IV pole
  2. excessive cycling of NIBP cuff
  3. UE tourniquet
  4. sheets that are too tight when arms tucked
26
Q

How does radial nerve injury present

A

wrist drop

inability to extend the hand and wrist

27
Q

How does median nerve injury present

A
  1. sensory deficit to palmar portion of thumb through medial 4th finger
28
Q

What are 3 causes of long thoracic nerve injury

Presentation

A
  1. lateral positioning
  2. trauma
  3. preexisting neuropathy

presentation = scapular winging

29
Q

What are 3 causes of obturator nerve injury

A
  1. excessive flexion of thigh toward groin
  2. excessive traction during lower abd surgery
  3. forceps delivery
30
Q

How does obturator nerve injury present

A
  1. inability to ADDuct leg

2. reduced sensation over medial aspect of thigh

31
Q

How can obturator nerve injury be prevented

A

minimize hip flexion

32
Q

What can cause femoral nerve injury

A

excessive traction during lower abd surgery

33
Q

How does injury of the femoral nerve present

A
  1. impaired knee extension and hip flexion

2. reduced sensation over the anterior thigh and anteromedial aspect of leg

34
Q

How can femoral nerve injury be prevented

A

avoid excessive traction during lower abd surgery

35
Q

What can cause saphenous nerve injury

A

MEDIAL aspect of leg leaning against supporting cradle in lithotomy position

36
Q

How does injury of the saphenous nerve present

A

reduced sensation over the anteromedial aspect of the leg

37
Q

How can saphenous nerve injury be prevented

A

place padding between leg and stirrup

38
Q

What can cause common peroneal nerve injury

A

compression of the LATERAL aspect of knee, usually against stirrups

39
Q

What are 3 presentations of common peroneal nerve injury

A
  1. foot drop
  2. inability to evert foot
  3. inability to extend toes dorsally
40
Q

What are 3 measures to prevent common peroneal nerve injury

A
  1. pad between leg and stirrup
  2. pad under fibular head
  3. knees should be flexed with minimal rotation
41
Q

2 positions that can cause sciatic nerve injury

A
  1. lithotomy w/ extreme hip flexion or external rotation

2. sitting straight leg

42
Q

How does sciatic nerve injury present

A

foot drop

43
Q

What are 3 measures to prevent sciatic nerve injury

A
  1. ample padding under buttocks
  2. avoid excessive external rotation of hips
  3. flex table at the knees
44
Q

What can cause a pudendal nerve injury

A

compression of the nerve against a perineal post on ortho fracture table

45
Q

How does pudendal nerve injury present

A

perineal sensation loss

APEX-Miscellaneous (6 decks)

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