Anesthesia Concepts 2 > Musculoskeletal > Flashcards
Musculoskeletal Flashcards
Elbow Flexion
C5, C6
Elbow Flexion
C5, C6
Elbow Extension
C6,C7,C8 (Same as grip)
Grip
C6, C7, C8 (Same as elbow extension)
Finger Abduction
C8, T1, Ulnar nerve
Opposition of the thumb
C8, T1, Median nerve
Hip Flexion and adduction
L2, L3, L4
Hip abduction
L4, L5, S1
Hip Extension
S1
Knee Extension
L2, L3, L4
Knee Flexion
L4, L5, S1, S2
Dorsiflexion
L4, L5
Plantar Flexion
S1
What is the Glascow Coma scale?
Defines neurological impairment Eyes open- 1-4 Best Verbal Response: 1-5 Best Motor Response: 1-6 8 or less is severe will require automatic intubation and controlled ventilation for ICP and airway control.
Plantar Flexion
S1
What are the MAOI’s to know?
Iproniazid, phenelzine, isocarboxazid, moclobemide, befloxatone, brofaromine, selegiline (for Parkinson’s)
What are some drugs that people with NMD are on?
Steroids, MAOIs, Methotrexate, Pergolide for PD
What are some drugs that people with NMD are on?
Steroids, MAOIs, Methotrexate, Pergolide for PD, Anticholinergics, Levodopa, Pain meds: Opiods, ASA, NSAIDS, Anticonvulsants, cholinesterase inhibitors (MG),
Guillane Barre: vasoactives, pressors or BBs
What are some drugs that people with Lupus might be on?
Ibuprofen, Indomethacin, ASA, CO2 inhibitors, DVT prevention, Steroids
What are some drugs people with RA could be on?
Methotrexate!!!! ASA, NSAIDS, immunosuppresives, steroids
What are some drugs people with myasthenia gravis could be on?
Cholinesterase inhibitors, steroids, immunosuppresives
What are some drugs people with Parkinsons disease might be on?
Levadopa, MAOIs, anticholinergics, history of Pergolide?
What are some concerns for the patient with MS?
● Demyelinating disease of the brain & spinal cord
● These patients are generally on immunosuppressive medications
○ Any recent history of illness or infection?
○ Take extra care with infection prevention
○ Which medications are they taking & how often?
○ Steroids in the past year????
● Remission & exacerbation intervals
● Severity & nature of symptoms
○ Respiratory status
○ Previous triggers or exposure
○ Paralysis (assess for motor strength)
○ Sensory disturbances (assess along dermatomes)
○ Autonomic disturbances (resting heart rate, orthostatic hypotension)
○ Visual impairment (cranial nerve check)
○ Seizures (medications)
○ Emotional Disturbances
● Counsel patient regarding ↑ relapse incidence with surgery
What are some concerns for patient with Guillan Barre?
● Document the severity & current state of symptoms
○ Facial paralysis: bulbar involvement (what other concerns might you have here????)
■ Problems at this level could involve brainstem issue
● I.e. HR, VS
○ Difficulty swallowing: pharyngeal muscle weakness
○ Impaired ventilation: current ventilatory support required (vent settings)
○ ↓ deep tendon reflexes: lower motor nerves
○ Extremity paresthesias
○ Pain: headache, backache, muscle tenderness + note medications helpful for controlling pain
recipitating factors
○ Onset of symptoms
○ Disease progression (worsening, stable, improving)
Document time course
**ANS dysfunction!
Concerns for patient with Parkinson?
● Progression destruction of dopermagenic neurons in the basal ganglia
● Age of diagnosis, recent exacerbations & hospitalizations
● Current & past symptoms (ex. oculogyric crisis, when? How long did it last? What helped?)
○ ANS symptoms (orthostatic BPs)
○ History of Pergolide therapy?
■ Withdrawn d/t causing valve dysfunction
○ Temperature regulation issues?
○ Pulmonary status optimized?
■ Dysphagia &/or dyspnea
On Levodopa? Note nature ROM of extremities
What are concerns with patient with acute spinal cord injury?
● Spinal Shock ○ Lesion above the heart → no ability to control the heart ● Acute (spinal shock) ○ Fluid & Blood Status ■ CBC, Type & Cross, Chem 7 ○ ECG/Chest X-ray ○ Vasopressor requirement? ○ Ventilatory support (current vent settings)? ■ C3, 4, 5 keep them alive ○ Associated injuries?
Concerns with chronic spinal cord injury?
○ Risk autonomic dysreflexia, especially with lesion above T10
○ History of autonomic dysreflexia? What initiated it?
○ Old OR/ICU records helpful → response to vasopressors, tracheal suctioning
○ Ventilatory reserve → level of lesion
○ Assessment of skin integrity
○ Positioning → note normal range of motion
Concerns with patient with seizure disorder?
● Type of seizure activity; typical length, frequency, severity, & recovery period
● Precipitating/causative factors (ETOH withdrawal)
● History of status epilepticus (how long did it last, how was it treated, were treatments effective)
● Pharmacologic Therapy:
○ Testing directed based on medications → CBC, platelet, electrolyte panel common
○ Routine levels of anticonvulsants unnecessary in patients with good seizure control
○ Cancel elective surgery until seizure disorder optimized by neurologist
SLE: Physical exam?
● Wide systemic autoimmune vasculitis
○ Higher risk with seizures
● Note natural range of motion (arthritis)
● Note neuromuscular strength, cranial & peripheral neuropathies
● Note mentation (CNS involvement)
● Fluid & electrolyte status → chemistry Panel
● Hematologic → CBC, PT/PTT & INR
● Possible chest X-Ray
● Skin: note existing rashes (not to be confused with allergic reactions periop)
● Distal extremities: Raynaud’s common → pulse ox readings difficult (use ear)
● Renal Function: glomerulonephritis, proteinuria, albumin level, chemistry panel
● Cardiac status: Echo, cardiac consult, pericarditis? Conduction abnormalities?, CHF, valvular dysfunction?
● Pulmonary status: pulmonary function tests (restrictive pattern)
● Gastrointestinal: prone to N/V?
SLE medications?
● Note dose amount, frequency, timing of last dose, side effects, etc. ● Drugs that affect coagulation status: ○ Ibuprofen ○ Indomethacin ○ ASA ○ Cox-2 Inhibitors ○ DVT preventative therapy → high DVT risk with lupus ● Immunosuppressive therapy ● Steroids ● Optimized by PCP or rheumatologist?
RA concerns and findings?
● Autoimmune disease that usually affects the joint but can be systemic
● Focus areas: airway, neurological, pulmonary, CV
● Note Natural Range of Motion
○ TMJ: limited mouth opening
○ Atlanto-axial joint: lateral neck radiograph or MRI
■ Can compress this joint & cause paralysis
○ Cricoarytenoid arthritis: hoarseness, pain on swallowing, dyspnea, stridor, laryngeal tenderness
■ Can have narrow airway
○ Individualized airway plan based on findings
● Issues with lungs possible
● Dyspnea is often a sign of cardiac ischemia in this population
○ PFTS & ABG if suspect lung involvement (restrictive pattern)
○ ECHO, ECG (cardiac conduction) especially if cardiac involvement suspected
● Consider effect of medications: ASA, NSAIDS, methotrexate, immunosuppressive drugs & steroids
○ Balance preference to continue meds with anti-coagulation & immunosuppressive characteristics
○ Very dependent on NSAIDs
Concerns with Myasthenia Gravis?
● Autoimmune destruction of Ach receptors at the NMJ
● Note degree of skeletal muscle weakness, progression of the disease
● Note medication history
○ Cholinesterase inhibitors
■ I.e. neostigmine
○ Steroids
■ May need supplementation before surgery
○ Immunosuppressive therapy
Concerns with Muscular Distrophy?
● Muscle wasting over time
● Note progression of the disease, natural range of motion, muscle strength
● Delayed gastric motility
● Ventilatory status (PFT, cough strength)
● Cardiac: ECG, perhaps ECHO
○ Can have issue on heart as well
