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Personal APA > Orthopedic > Flashcards

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
Q

What is the pathogensis of DVT and PE?

A

-Venous stasis and hypercoagulability from inflammation

26
Q

How does neuraxial anesthesia help in reduce DVT and PE?

A
  • Increase in venous blood flow
  • Antiinflammatory effects
  • Decreased platelet activity
  • Less stress hormone
27
Q

Placement or removal of an epidural needle or catheter should not be undertaken within ____ of a SQ minidose of heparin or with _____ of LMWH

A
  • 6-8 hours

- 12-24 hours

28
Q

Hallmarks of hematoma?

A
  • Back pain
  • Lower extremity weakness
  • Incontinence
29
Q

_____and ______ that limit ROM of a joint may require anesthesia for manipulation to occur

A
  • Scars

- Adhesions

30
Q

What allows surgeons to distinguish between anatomical limitations and patient guarding.

A

-Profound relaxation

31
Q

What things may be needed in a close reduction

A
  • Pins
  • Xray/Fluoro
  • Cast / splint
32
Q

With hip fx, need to determine the cause of the fall prior to surgery. Common reasons are?

A
  • Accident
  • Neuro event
  • C/V event
  • Dementia
  • Dehydration
33
Q

Hip fx mortality is ____ during hospitalization and ____ during the 1st year.

A
  • 10%

- 25%

34
Q

Name 2 reasons to delay hip surgery.

A
  • Coaglopathy

- Uncompensated heart failure

35
Q

Hip surgery consderations

A
  • Surgery w/i 48 hours
  • Type and cross
  • Check hypoxia
36
Q

5 predictors of hip fx mortality

A
  • > 85 yo
  • Hx of CA
  • Neuro decline
  • Chest infection (pneumonia)
  • Wound infection
37
Q

Benefits of regional in hip surgery.

A
  • Decreased blood loss
  • Reduced DVT/PE
  • Faster return to baseline neuro
  • Hypobaric technique
38
Q

How can you lose benefit regional?

A
  • Oversedation

- Hypoxia

39
Q

After ______ months there is no difference in mortality between regional and general.

A

-2 months

40
Q

Blood loss from hip fx depends on what? and in what order?

A

-Location of fx
-subtrochanteric,intertrochanteric >
base of femoral neck>
transcervical, subcapital

41
Q

When would you use general anesthesia with hip fracture? And what should be used?

A
  • Bigger fx = longer surgery
  • Short acting drugs
  • Lower soluble agents
42
Q

How can you minimize post op cognitive impairment?

A
  • Minimal use of versed
  • maintain O2
  • Maintain hgb
  • Maintain normal capnea
43
Q

What is an arthroscopy? What are the benefits of arthroscopy?

A
  • Examine interior joint w/ endoscope

- Less EBL, Pain, Rehab

44
Q

What can be done with and arthroscopy?

A
  • Definitive diagnosis
  • Menisectomy
  • Loose body removal
  • Cruciate ligament repair
45
Q

What drug is helpful for arthroscopic procedures?

A

-Ketorolac

46
Q

Goals of Total hip

A
  • Pain relief
  • Correct deformity
  • Joint stability
47
Q

Total hip indications

A
  • Osteoarthritis
  • Rheumatoid arthritis
  • Vascular necrosis
48
Q

What is Rheumatoid arthritis?

A

-Immune mediated joint destruction w/ synovial inflamation

49
Q

What can cause RA and where else can it be found?

A
  • Use of steroids, antiinflammatories, methotrexate

- Atlantoaxis (c1/2) and TMJ

50
Q

What causes vascular necrosis?

A
  • Injury

- Drug abuse

51
Q

When is and embolic event most frequent?

A

-Insertion of femoral componet

52
Q

How much blood loss can you expect with a total hip? Hip Revision?

A
  • 400-1500

- 2000

53
Q

Knee blood loss vs Hip blood loss?

A

-Knee has less intraop blood loss (100-200) but greater overall blood loss post op.

54
Q

What procedure has the highest rate of DVT among all ortho procedures?

A

-Total knee

55
Q

Upper extremity surgery considerations.

A
  • Sitting or Lat decub position
  • Interscalene block
  • Maintain BP
  • No tourniquet / blood loss
  • Pneumothorax
  • Subclavian vein injury
  • Extubation
  • Venous air embolism
56
Q

Anesthesia considerations for foot and ankle surgery?

A
  • Regional
  • Nerve block w/ sedation
  • Use of tourniquet
  • LMA
  • Local injection for post op pain
57
Q

Amputations concerns?

A
  • Psychological trauma

- Phantom limb pain

58
Q

How would you maintain blood flow in a limb re-implantation?

A
  • Optimal HCT 28-30%
  • Keep warm
  • Avoid vasoconstrictors
  • Dextran or heparin infusion
59
Q

Shoulder needs what type of block?

A

-Interscalene

60
Q

Problems with interscalene blocks?

A
  • Pneumothorax
  • 100% phrenic nerve block
  • Horner’s
  • Hoarsness
  • Decreased chest wall sensation

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