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Orthopedic Flashcards

1
Q

What 3 things happen to bone cement that lead to intermedullary hypertension?

A
  • Heat
  • Expansion
  • Hardening
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2
Q

Intermedllary hypertension leads to what 4 things moving where?

A
  • Fat emboli
  • bone marrow
  • cement
  • air
  • Into the femoral venous channel
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3
Q

Residual mma monomer can do what 2 things?

A
  • Vasodilation

- Decrease SVR

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4
Q

Bone cement can cause tissue thromboplastin release, what 3 things does tissue thromboplastin cause?

A
  • Platelet aggregration
  • Microthrombus in lungs
  • CV instability
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5
Q

What are the 6 problems associated with bone cement syndrome?

A
  • Hypoxia
  • Hypotension
  • Dysrhythmias
  • Decreased CO
  • Pulmonary HTN
  • Embolization
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6
Q

6 problems with pneumatic tourniquets.

A
  • Hemodynamic changes
  • Pain
  • Metabolic changes
  • Thrombus
  • Muscle/nerve injury
  • Limb cooling
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7
Q

Prolonged cuff time of 45 - 60 minutes leads to what?

A
  • HTN
  • Tachycardia
  • Sympathetic stimulation
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8
Q

Cuff deflation drops what 3 things?

A
  • CVP
  • MAP
  • Temp
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9
Q

Cuff pressure should be what? and what are the limits?

A
  • 100 torr above systolic pressure
  • Upper extremity = 250
  • Lower extremity = 350
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10
Q

Tourniquet pain is caused by what type of fibers? and feels like what?

A
  • Slow, unmylenated C fibers

- Aching and burning

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11
Q

What is will you see when the cuff is deflated?

A
  • Increase in end tidal CO2
  • lactate
  • Potassium
  • Increase in minute volume
  • Possible dysrhythmias
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12
Q

Reperfusion injuries can happen from what?

A

-Free radical formation

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13
Q

Tourniquets are contraindicated in what?

A

-Calcified arteries

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14
Q

Prolonged tourniquet time of greater than 2 hours leads to what injuries?

A
  • Muscular
  • Nerve
  • Rhabdo
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15
Q

When does fat embolism syndrome occur? and what are the triad of symptoms?

A
  • w/i 72 hours of long bone or pelvic fx
  • Dyspnea
  • Confusion
  • Petechiae
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16
Q

Where else can fat embolism syndrome be seen?

A
  • CPR
  • Liposuction
  • IV lipids
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17
Q

Where does fat emboli enter circulation?

A

-Tears in medullary vessel

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18
Q

Fat embolism syndrome releases amines and prostaglandins that can cause what 3 things?

A
  • ARDS
  • Cerebral capillary damage
  • Edema
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19
Q

How does fat embolism syndrome effect coagulation?

A
  • Throbcytopenia

- Increased clotting time

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20
Q

Where are petechiae found during fat embolism syndrome?

A
  • Chest
  • Upper extremities
  • Conjunctiva
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21
Q

Where are fat globules seen fat embolism syndrome?

A
  • Retina
  • Urine
  • Sputum
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22
Q

Fat embolism respiratory concerns.

A
  • Anywhere from mild hypoxia to ARDS
  • Decrease in ETCO2 and SPO2
  • Increase in PAP
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23
Q

Risk factors for DVT / PE in ortho?

A
  • > 60 yo
  • Obesity
  • Tourniquet
  • Procedure >30 min
  • lower extremity fx
  • Immobilization > 4 days
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24
Q

What procedures are at highest risk for DVT / PE?

A

-Knee and Hip replacment

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25
What is the pathogensis of DVT and PE?
-Venous stasis and hypercoagulability from inflammation
26
How does neuraxial anesthesia help in reduce DVT and PE?
- Increase in venous blood flow - Antiinflammatory effects - Decreased platelet activity - Less stress hormone
27
Placement or removal of an epidural needle or catheter should not be undertaken within ____ of a SQ minidose of heparin or with _____ of LMWH
- 6-8 hours | - 12-24 hours
28
Hallmarks of hematoma?
- Back pain - Lower extremity weakness - Incontinence
29
_____and ______ that limit ROM of a joint may require anesthesia for manipulation to occur
- Scars | - Adhesions
30
What allows surgeons to distinguish between anatomical limitations and patient guarding.
-Profound relaxation
31
What things may be needed in a close reduction
- Pins - Xray/Fluoro - Cast / splint
32
With hip fx, need to determine the cause of the fall prior to surgery. Common reasons are?
- Accident - Neuro event - C/V event - Dementia - Dehydration
33
Hip fx mortality is ____ during hospitalization and ____ during the 1st year.
- 10% | - 25%
34
Name 2 reasons to delay hip surgery.
- Coaglopathy | - Uncompensated heart failure
35
Hip surgery consderations
- Surgery w/i 48 hours - Type and cross - Check hypoxia
36
5 predictors of hip fx mortality
- >85 yo - Hx of CA - Neuro decline - Chest infection (pneumonia) - Wound infection
37
Benefits of regional in hip surgery.
- Decreased blood loss - Reduced DVT/PE - Faster return to baseline neuro - Hypobaric technique
38
How can you lose benefit regional?
- Oversedation | - Hypoxia
39
After ______ months there is no difference in mortality between regional and general.
-2 months
40
Blood loss from hip fx depends on what? and in what order?
-Location of fx -subtrochanteric,intertrochanteric > base of femoral neck> transcervical, subcapital
41
When would you use general anesthesia with hip fracture? And what should be used?
- Bigger fx = longer surgery - Short acting drugs - Lower soluble agents
42
How can you minimize post op cognitive impairment?
- Minimal use of versed - maintain O2 - Maintain hgb - Maintain normal capnea
43
What is an arthroscopy? What are the benefits of arthroscopy?
- Examine interior joint w/ endoscope | - Less EBL, Pain, Rehab
44
What can be done with and arthroscopy?
- Definitive diagnosis - Menisectomy - Loose body removal - Cruciate ligament repair
45
What drug is helpful for arthroscopic procedures?
-Ketorolac
46
Goals of Total hip
- Pain relief - Correct deformity - Joint stability
47
Total hip indications
- Osteoarthritis - Rheumatoid arthritis - Vascular necrosis
48
What is Rheumatoid arthritis?
-Immune mediated joint destruction w/ synovial inflamation
49
What can cause RA and where else can it be found?
- Use of steroids, antiinflammatories, methotrexate | - Atlantoaxis (c1/2) and TMJ
50
What causes vascular necrosis?
- Injury | - Drug abuse
51
When is and embolic event most frequent?
-Insertion of femoral componet
52
How much blood loss can you expect with a total hip? Hip Revision?
- 400-1500 | - 2000
53
Knee blood loss vs Hip blood loss?
-Knee has less intraop blood loss (100-200) but greater overall blood loss post op.
54
What procedure has the highest rate of DVT among all ortho procedures?
-Total knee
55
Upper extremity surgery considerations.
- Sitting or Lat decub position - Interscalene block - Maintain BP - No tourniquet / blood loss - Pneumothorax - Subclavian vein injury - Extubation - Venous air embolism
56
Anesthesia considerations for foot and ankle surgery?
- Regional - Nerve block w/ sedation - Use of tourniquet - LMA - Local injection for post op pain
57
Amputations concerns?
- Psychological trauma | - Phantom limb pain
58
How would you maintain blood flow in a limb re-implantation?
- Optimal HCT 28-30% - Keep warm - Avoid vasoconstrictors - Dextran or heparin infusion
59
Shoulder needs what type of block?
-Interscalene
60
Problems with interscalene blocks?
- Pneumothorax - 100% phrenic nerve block - Horner's - Hoarsness - Decreased chest wall sensation

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