Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NU 758 Adv Principles > ortho > Flashcards

ortho Flashcards

1
Q

SCIP aims to decrease peri-op risks assoc w/ what factors

A

SSI, post-op VTE, peri-op glucose mgmt, & maintenance of normothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when should ancef be given? vanc?

A

within 1 hr of incision
vanc: 2h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 respiratory concerns for older patients undergoing ortho sx

A
  1. decreased PaO2
  2. increased closing volumes
  3. decreased FEV (10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

STOP-BANG criteria

A

Snore?
Tired during the day?
Observed apnea?
Pressure (HTN)?
BMI > 35
Age >50
Neck circumference >40cm
Gender: male
(3+ is high risk for OSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cardiac concern with ortho sx (2)

A
  1. SIRS leading to tachycardia, HTN, high O2 demand, and MI
  2. blood loss/fluid shifts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a common neurologic complication post-op ortho sx

A

delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

intra-op RF for delirium (7)

A

hypoxemia, hypoTN, hypervolemia, electrolyte imbalances, pain, benzos, anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

components of the pneumatic tourniquet

A

inflatable cuff, connective tubing, pressure device, timer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

purpose of pneumatic tourniquet

A

creates a relatively bloodless field, minimized blood loss, and improves surgical view

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

max time you can have pneumatic cuff inflated

A

2h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what pressure do you put tourniquet to (upper and lower ext)

A

upper: 70-90mmHg above SBP
lower: 2x SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when are somatosensory EPs and nerve conduction abolished w pneumatic tourniquet

A

within 30 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when does pain and HTN occur w tourniquet

A

> 60min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

if tourniquet is inflated over 2h what happens

A

postop neuropraxia (loss of sens/motor function)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

6 effects of pneumatic tourniquet

A

HTN, pain, leaky capillaries, nerve conduction issues, acidosis, tissue hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

tourniquet deflation causes release of…

A

acid metabolites like thromboxane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

5 effects seen with tourniquet deflation

A
  1. transiet fall in temp
  2. transient met acidosis
  3. transient fall in CvO2
  4. transient fall in pulm & systemic arterial pressures
  5. transient INCREASE in EtCO2
    (treat cautiously bc effects are transient)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

describe tourniquet pain

A

-ischemic pain like DVT/PVD pain
-starts as dull/aching –> burning & excruciating pain
-resistant to analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what fibers cause burning/excruciating oain

A

unmyelinated c fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what type of pain fibers control pinprink, tingling, and buzzing pain

A

myelinated a-delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what can you add to LA solns to help w tourniquet pain

A

opioids, toradol, melatonin, clonidine, dex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

purpose of TXA & MOA

A

antifibrinolytic: prevents the breakdown of existing clots to prevent bleeding intra-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

TXA dose

A

1g in 50ml over 5-10min, 5-20 min before incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

contraindications to TXA (5)

A

clotting disorders, acquired defective color vision, SAH, active clotting, hypersens to TXA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

relative contraindications to TXA (3)

A

hx of vascular occlusive events, taking a procoagulant, taking oral contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

deliberate hypoTN…what parameters for BP

A

if no HTN: SBP 80-90 & MAP 50-65

if HTN: 30% reduction of baseline MAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

risks of deliberate hypoTN

A

-vision loss
-complications in ppl with CV, renal, hepatic, severe PV diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

contraindications for deliberate hypoTN

A

uncorrected hypovolemia and severe anemia
(although this is not used in general today)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what surgeries have a high risk of VTE

A

pelvic fx, hip fx, TKA, THA
(less common w/ upper ext fx/sx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

leading cause of M&M after orthopedic sx

A

thromboembolism

31
Q

treatment/prevention choice for VTE

A

LMWH (up to 35 days post op)

32
Q

RF for VTE (5)

A

age, cancer, bedrest, Factor V Leiden, hx of DVT/PE

33
Q

3 major features of fat embolism syndrome (diagnosis needs at least 1)

A

respiratory insufficiency
cerebral involvement
petechial rash

34
Q

5 minor features of fat embolism syndrome (diagnosis needs at least 4)

A

pyrexia, tachy, retinal changes, jaundice, renal changes

35
Q

lab features of fat embolism syndrome

A

fat microglobulinemia
anemia, thrombocytopenia, high ESR

36
Q

what value is required for FES diagnosis

A

fat microglobulinemia

37
Q

most common site of injury for acute compartment syndrome (ACS)

A

tibial diaphysis (midshaft)

38
Q

what are the 4 muscle compartments in the lower leg

A

ant, lateral, deep posterior, superficial posterior

39
Q

s/s of ACS

A

5P’s: pain, pallor, paresthesias, pulselessness, paralysis

-may also see swelling (if no cast) and pain on passive stretch

40
Q

what is normal compartment pressure in the leg and when does injury occur

A

<10mmHg normal
30-50mmHg + injury

41
Q

treatment for ACS

A

fasciotomy

42
Q

risks with sitting position

A

hypoTN, bradycardia, air embolism, PTX, cerebral hypo-perfusion

43
Q

where do you measure BP in the sitting position

A

level of brain

44
Q

lateral position considerations

A

protect ear
use ax roll
avoid twisting of spine (beanbags/braces)
non-dep arm on a padded arm holder
dependent arm padded and <90 degrees at the elbow

45
Q

concern with knee surgery positioning

A

table bends at the knee so legs dangle, risk for blood pooling, DVT. use compression devices

46
Q

what positions is elbow sx done in and what has best limb stability

A

supine, lateral, prone

prone

47
Q

considerations with fracture table

A

-risk of pt sliding
-arms are bent so no IV in the AC
-temp control bc most of pt is exposed

48
Q

3 benefits to arthroscopy

A

reduced blood loss, less postop pain, reduced rehab time

49
Q

general complications with arthroscopy

A

-SubQ emphysema/pneumomediastinum
-life-threatening tension PTX*
-eye injury
-joint irrigation fluid –> fluid overload
-rare: trocar vessel puncture

50
Q

if peak inspiratory pressures rise, O2 sat drops, and no breath sounds on operative side suspect…

A

tension PTX

51
Q

treatment for tension PTX

A

-chest tube ideal
-needle decompression wth 14-18g angiocath inserted 2 or 3rd ICS anteriorly OR 4 or 5th ICS laterally

52
Q

is regional or GA better for hip fracture sx? what are advantages to regional?

A

no difference per REGAIN study

regional: avoids ETT/med admin, lower VTE risk, vasodilation from spinal can help with CHF patients

53
Q

what is cause of mortality with pelvic fractures

A

RP bleed

54
Q

purpose of arthroplasty

A

return motion and function of the joint and restore the controlling function of the surrounding soft tissues
-pain relief, stability of joint motion, and correction of the deformity

55
Q

what are prosthesis made of for arthroplasty

A

titanium or cobalt (nonferrous metals)

56
Q

anterior vs posterior approach for THA: positioning

A

ant = fracture table (supine)
post = lateral

57
Q

2 risk with THA

A
  1. high EBL from highly vascular femur (500-1000ml)
  2. VTE
58
Q

whats 7 RF for BCIS (bone cement implantation syndrome)

A
  1. hx CV disease
  2. pHTN
  3. ASA 3+
  4. surgical technique (must use cement, hips>knees)
  5. pathological fracture
  6. trochanteric fracture
  7. long-stem arthroplasty
59
Q

6 s/s of BCIS

A
  1. hypoxia
  2. hypoTN
  3. arrhythmias
  4. increased PRV
  5. loss of consc
  6. cardiac arrest
60
Q

first sign of BCIS under GA? if awake/sedation?

A

GA: drop in EtCO2
awake/sed: dyspnea and change in LOC

61
Q

BCIS treatment

A

FiO2 100% and treat like R sided HF with aggressive IVF and hypoTN with alpha-agonists

62
Q

why do some surgeons avoid regional anesthesia with shoulders

A

concern for postop neurologic symptoms

63
Q

shoulder surgery concerns

A
  1. high EBL bc vascular area
  2. PONV
  3. pain
  4. long recovery time
64
Q

2 analgesia options wiht shoulder sx

A

interscalene block and post-op nerve catheters with LA infusion

65
Q

2 position options for TSA

A

lateral decubitus or beach chair (modified Fowler)

66
Q

major risk with TSA

A

inadvertent extubation from positioning and sx manipulation near the head
(also protect eyes and avoid c-spine stretching)

67
Q

Nerve:
innervation:

A
68
Q

Nerve: post tibial
innervation:

A

plantar surface

69
Q

Nerve: saphenous
innervation:

A

medial malleolus

70
Q

Nerve: deep peroneal
innervation:

A

space btwn big and 2nd toe

71
Q

Nerve: superficial peroneal
innervation:

A

dorsum of foot and toes 2-5

72
Q

Nerve: sural
innervation:

A

lateral foot and 5th toe

73
Q

temp consideration with MS patients (from jeopardy, idk if related to this content?)

A

don’t warm them too much. Keep normo bc 1C higher can cause issues

74
Q

6 complications from sterile water irrigation fluid during TSA

A

fluid overload, hypoNA, pulm edema, CHF, hypothermia, and airway compromise

NU 758 Adv Principles (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions