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Principles > Ortho > Flashcards

Ortho Flashcards

1
Q

Osteoporosis risk factors (2)

A

Age related
Post menopausal (women)
Increased risk for fractures

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2
Q

Causes of osteoporosis (2)

A

1)Increased parathyroid hormone
2)Decreased vitamin D, growth hormone and insulin- like growth factors

3) Stress fractures; Compression fractures of the lumbar/ thoracic or Proximal femur & humerus & wrist

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3
Q

Meds that help osteoporosis (4)

A

Fosamax, Actonel , boniva, reclast

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4
Q

Osteoarthritis pathology

A

Loss of articular cartilage -> inflammation = pain
Usually weight-bearing joints (knee/ spine/ neck/ hips, shoulders)

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5
Q

Risk factors for osteoarthritis

A

Age > 65

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6
Q

S/S of osteoarthritis (4)

A

-Pain
-Creditance; grating sound caused by friction
-Decreased mobility; activity level declines as the day progresses because of the pain
-Joint deformity; Heberdon nodes (distal interphalangeable joints). Bouchard nodes (proximal interphalangeal) joints.

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7
Q

What percent of osteoarthritis pts experience physical limitations

A

8%

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8
Q

Meds/ treatment for osteoarthritis

A

NSAIDs; Meloxicam
Celebrex; cox 2
opioids
Topical treatment; diclofenac (Voltaire’s; NSAID OTC)
Intraarticular therapy; steroid injections
Chondroprotective agents; Glucosamine
Occupational therapy
Wt loss
Acupuncture
TENS; transcutaneous electrical nerve stimulation

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9
Q

What is glucosamine?

A

A natural compound found in cartilage.

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10
Q

When should herbal medications be stopped before sx and what do they affect?

A

Stop 2 weeks before sx and they affect plat aggregation
Glucosamine/ ginger, ginko

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11
Q

Rheumatoid arthritis pathophysiology

A

Chronic and systemic inflammatory disease
Joint synovial tissue/ connective tissue inflammation leads to;

Bone erosion
Cartilage destruction
Impaired joint integrity

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12
Q

S/S of RA

A

1)Multiple joints involved; wrist and metacarpophalangeal joints
2)Pain, stiffness
* morning stiffness
3) Anorexia, fatigue, weakness
4) Sub q (rheumatoid) nodules surround joints, extensor surfaces, and bony prominences

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13
Q

Labs to diagnose RA

A

Increased;
Rheumatoid factor,
antiimmunoglobulan antibody,
CRP,
Erythrocytes sedimentation rate

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14
Q

Meds for RA

A

Glucocorticoids; stress Dose
NSAIDS
Opioids
Methotrexate (antineoplastics)
Hydroxychloroquine (antimalaria immunosuppressive)
Sulfasalazine (DMARD)
Leflunomide (DMARD)
Infliximab (Remicade) IgG monoclonal antibody. inhibit TNF alpha.
Etanercept (Enbrel) TNF alpha inhibitor.

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15
Q

Stress dose steroids

A

50 mg of solucortef hydrocortisone

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16
Q

RA anesthesia concerns

A

Airway; limited TMJ movement (Temporomandibular joint)
Narrowed Glotic opening; smaller tube?
Circoarytenoid arthritis
Pain on swallowing
Strider
Tenderness of the larynx
Atlantoaxial instability; displace odontoid (dens) process -> impingement of spine and medulla
Vertebral artery compression

Atlantoaxial subluxation; x ray. HA, neck pain, up and LE parenthesis w/ movement, bladder/ bowel dysfunction.

Sjorgens syndrome (dry eyes/ mout)
Diffuse interstitial fibrosis
Restrictive ventilation pattern
Vascultitis/ pericarditis
Cardiac tamponade
Gastric ulcers
Renal insufficiency (age or nsaid use)

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17
Q

Axis and atlas

A

C1= atlas
C2= axis

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18
Q

Vent mode for pts with restrictive lung dz

A

pressure controlled and volume guaranteed to ensure not over-inflating the lungs

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19
Q

Intervention for atlantoaxial subluxation symptoms

A

Evaluate c-spine flexion & extension x-rays

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20
Q

Vt set range for rheumatoid arthritis

A

5 ml / kg

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21
Q

Vertebral artery occlusion symptoms from RA

A

N/v
Dysphasia
Blurred vision
Transient LOC

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22
Q

Ortho injury anesthesia concerns

A

Hemorrhage, shock, fat embolism
Full stomach d/t emergent nature of the fixation/ repair
Pelvic fractures -> iliac artery-> retroperitoneal space bleeding
Long bone fix -> bone marrow fat -> venous circulation -> thromboembolic-> hypoxia respiratory failure.

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23
Q

ABCD’s of trauma anesthesia

A

GETA; aspiration vs hypoxia
RSI
Preoxygenation
Circoid pressure; Sellick maneuver (10 lbs or 30 newtons)
Induction meds; ketamine/ etomidate
Muscle relaxation; sux/ roc
Apneic ventilation (Boyles law) or modified RSI
DL after 3 attempts -> combtitube or LMA

24
Q

What is the other name/ pressure for cricoid pressure?

A

Cricoid Pressure, aka Sellick Maneuver (10 lbs or 30 Newtons)

25
Q

Boyles law

A

pressure and volume of a gas have an inverse relationship

26
Q

MILS

A

Manual in line stabilization
For head and neck in neutral position when pt not been cleared
Stabilize head and neck w/ no cephalad traction
Intubation
Stabilize shoulder

3 clinicians; shoulder, intubation, stabilize head

No jaw thrust, chin lift, and head tilt do restyles in c spine movement

27
Q

Risk factors for ortho surgery

A

age > 85 yo
ETOH (consider cyp450)
Preop dementia/ cognitive impairment (dont do neuraxial)

28
Q

Fev1 decreases by……

A

Fev1 decreases by 10% / decade

29
Q

Triggers for delirium

A

Hypoxemia, hypotension, hypercarbia, sleep deprivation

Hypervolemia(dilutes electrolytes) , infection

Abnormal e-lytes

Pain

Administration of benzos & anticholinergics

30
Q

Age related concerns for Respiratory status

A

decrease paO2
increased closing volume
FEV1 decreases by 10%/ decade
Obesity
OSA (stop Bang)

31
Q

Target HR

A

Continue beta-blockers
Initiate beta-blockers if high risk
Target HR < 80 bpm

32
Q

Fat emboli concern intra op, triad s/s, and labs

A

Common in pelvic and femoral fax
Long bone trauma -> release of fat droplets into the venous system
Fx releases mediators affecting the solubility of lipids in circulation

Symptoms in 12-72 hrs.

Triad; dyspnea, confusion, petechiae. Treat with increasing BP

Labs; fat macroglobinemia. Anemia and thrombocytopenia. Elevated Sed rate.

33
Q

stop bang

A

Snoring
Tired
Observed stoping breathing
High blood pressure

BMI> 35
Age over 50 \neck circum
Gener; male?

34
Q

What is fat metabolized to

A

free fatty acids

35
Q

Normal SED rate male

A

0-22mm/hr

36
Q

Normal SED rate female

A

0-29 mm/hr

37
Q

Treatment of FES

A

Stabilize fracture
100% o2 , no n2o
Increased bp
Heparin IV

38
Q

When do FES symptoms resolve

A

3-7 days

39
Q

DVT medication prophylaxis

A

LMWH; 12 hrs preop or 12 hrs post op
IV or SQ heparin
LMWH in Neuraxial ok to do 10-12 hrs after previous dose. Delay next dose 4 hrs
warfarin; Neuraxial okay if INR </ = 1.5

40
Q

DVT prophylaxis if the neuraxial catheter is not okay

A

remove catheter 2+ hrs before 1 st dose
Once catheter removed = delay 2 more hours before doing the LMWH

41
Q

Surgeries at greatest risk for DVT/PE

A

Hip surgery
TKA
Lower extremity trauma

42
Q

risk factors for DVT/ PE

A

Obesity
Age > 60 yo
Procedure length > 30 mins
Use of tourniquet
Lower extremity fractures
Immobilization > 4 days
Without prophylaxis: occurs 40-80%

43
Q

Warfarin considerations for DVT prophylaxis and neuraxial anesthesia

A

Neuraxial anesthetic okay if INR < / = 1.5

44
Q

TXA max

A

2.5 gm

Normal dosing; 10-30mg/kg

45
Q

Concerns for TXA

A

Risk of VTE ?
Risk of MI, CVA, TIA ?
Many postop CV complications R/T anemia & blood transfusion

46
Q

When to stop plavix prior to neuraxial

A

5-7 days

47
Q

Width of tourniquet

A

> 1/2 diameter of the entire limb

48
Q

What is an esmarch

A

Exsanguination
Increase blood volume into central circulation.

49
Q

Advantages of doing a neuraxial with a pt that’s at risk for DVT

A

Increased lower extremity venous blood flow d/t sympathectomy
Systemic anti-inflammatory properties of local anesthetics
Decreased platelet reactivity

50
Q

When does tourniquet pain begin?

A

After 45 min of being up
Tourniquet Pain begins after 45 mins: Regional Anesthesia supplement

51
Q

Tourniquet inflation pressures and time

A

Thigh 100 mmhg > SBP
Arm 50 mmhg > sbp

UE 250 mmhg
LE 300 mmhg

Generally not to exceed 2 hrs. Max time 3 hrs = 180 min,

52
Q

What to document for tourniquet

A

Inflation time
Deflation time
Total inflation time
Inflation pressure and any adjustments

53
Q

Risk of tourniquet > 2 hrs

A

Nerve injury
Risk of ischemia and rhabdomyolysis
Mechanical trauma

After 3 hrs; Mini is risk by delaying tourniquet 20-30 minutes to allow for reperfusion then can reinflate after 30 min

54
Q

Double tourniquet technique

A

Inflated proximal then deflate the distal

55
Q

What causes the pain from the tourniquet

A

Tourniquet time/ malposition or pressure
Anesthesia technique
Dermatomal spread/ peripheral nerve coverage
Local anesthetic and dose (density)

56
Q

Effects seen after deflation of the tourniquet

A

Metabolic acidosis
Hyperkalemia
Hypercarbia; lactic acid
Tachycardia and htn
Pain relieved
Decreased cvp, bp and temp
Transient lactic acidosis
Transient hypercarbia
Increased Minute ventilation

Principles (34 decks)

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