Orthopedic Fractures Flashcards
With a trohanteric and subtronanteric fracture, how much blood are you expecting to lose?
1200 mL
How do you treat a trohanteric and subtrohanteric fracture?
Screws into the leg with side plates
What happens in a intrascapular hip fracture?
Bleeding into hip 800 mL
Slow healing with increased risk of aseptic necrosis but lower mortality rate
What are some General anesthetic considerations for hip surgery?
Supine or lateral position
General v. RA + MAC
Monitoring –> consdier arterial line
Managing blood loss
Risk for thromboembolic event
What is the treatment for a inter scapular hip fx?
Screws –> Austin Moore
With any hip fracture, what should you be asking your patient?
What caused the injury –> MVC, Fall, ETC
Fall –> What precipitated the fall
MVC –> any additional injuries?
In a total hip arthroplasty, what is the order of events?
- hip is dislodged and femoral head is removed
- acetabulum is enlarged preparing for the prosthesis
- Acetabular prosthesis is held in place with two screws
- Femoral prosthesis is placed
What happens in a total knee arthroplasty?
Supine position
Spinal, epidural or GA
Femoral or Psoas + Sciatic Blocks
Intraarticular pain management
Why does intra-articular pain management improve outcomes?
Decreased level of pain
Earlier PT
Decreased N/V
Earlier discharge
Decreased GI disturbance
Earlier extubation
decreased delirium
Increased revenue (increased # of pt seen in a day)
With a spinal anesthetic, how long do you need to be off of Plavix for needle placement?
7 days
With a spinal anesthetic, how long do you need to be off of Coumadin for needle placement?
Normal INR 1.4 after 5 days
With a spinal anesthetic, how long do you need to be off of NSAIDS for needle placement?
No delay
With a spinal anesthetic, how long do you need to be off of Ticlid for needle placement?
14 days
With a spinal anesthetic, how long do you need to be off of Xalerto and Rivaroxaban for needle placement?
3 days
What is scoliosis?
A deformity of the spine resulting in lateral curvature and rotation of vertebrae and deformity of rib cage
When is surgical correction of scoliosis considered?
COBB angle >50%
What is the goal with surgery for scoliosis?
Stop cardiac and respiratory compromise associated with curves
What are the major anesthetic considerations related to positioning of a lumbar laminectomy?
Chest wall and abdominal compression decreases respiratory and venous return leading to decreased preload
Prone = decreased R heart filling pressures resulting in decreased BP and/or HoTN
POVL
Blood loss increased
Venous Air embolism
What does a venous air embolism look like?
Increased EtNO2
HoTN
Mill Wheel Murmur
How do you treat a venous air embolism
Wound irrigation with saline
N2O D/C
Vasopressor
Aspiration of air from CVP if in place
Lay patient right side up
How can you decrease the need for blood transfusion?
Use of tourniquets (if appropriate)
Controlled HoTN
Preopeative HBG optimization with Iron and erythropoietin
Autologous blood donation
Acute normovolemic hemodilution
Cell Saver
TXA
What is acute normovolemic hemodilution?
blood taken off and replaced with crystalloid or colloid just before incision –> allows for infusion of pt own blood when needed and bypasses errors with blood bank
What is a cell saver?
Saves blood and divides it up
Requires another person
CANNOT BE DONE WITH CANCER
What is TxA?
Transexamic acid
Antifibrinolytic therapy
inhibits clot breakdown by reducing the binding of plasminogen to fibrin
What is the patho of a Fat embolus?
occurs with insertion of prosthesis, reduction of joint or tourniquet deflation
Anticipate prior to bone cement
Associated with multiple traumatic injuries and surgeries of long bones
Fat globules lodge in pulmonary vasculature resulting in obstruction of pulmonary circulation
Fat globules are hydrolyzed into free fatty acids that are directly toxic to the pulmonary endothelium and pneumocytes resulting in
- Endothelial damage
- Platelet Adhesion with clot formation
- Capillary leakage and perivascular bleeding
What are some common s/sx of Fat Embolism Syndrome?
Pulm distress
AMS
Petechial Rash
Decreased PaO2
Elevated CRP
CV collapse
What is the treatment for fat embolic
Hydration
Vasopressors for HD support
Increase FiO2
Steroids to reduce inflammatory response
What is Bone Cement implantation syndrome?
due to fat emboli and debris from the intramedullary canal of long bones during manipulation, reaming and cementing
What are some s/sx of bone cement implantation?
Fever
Tachycardia
Hypoxemia
Dyspnea
Tachypnea
HoTN
Low ETCO2
Right axis deviation
RBBB
RV FAILURE AND CARDIAC ARREST
What is the treatment for bone cement implantation syndrome?
Fluids, Maximize FiO2, Inotropes/pressors, No N2O
REMAIN INTUBATED
