Orthopedics Flashcards
1
Q
orthopedics - the largest post-operative problem is ________
A
post-operative pain
2
Q
rheumatoid arthritic versus osteoarthritis
A
- rheumatoid: inflammation of synovial membrane, can have some bone erosion
- osteoarthritis: wearing down of cartilage membrane
3
Q
where should the endotracheal tube end on a sitting X-ray?
A
where the clavicles join
4
Q
rheumatoid arthritis
A
- limited neck movement: synovitis of cervical spine, TMJ, larynx, pulmonary system and inflammation of intervertebral discs and atlanto-occipital subluxation
- limited TMJ opening
- pulmonary lesions
- hoarseness and inspiratory stridor may indicate a narrowing or fixation of glottic opening due to cricoarytenoid arthritis
*awake fiberoptic intubation
5
Q
ankylosing spondylitis
A
- chronic inflammatory process, primarily in spine
- associated with conduction delays, valve lesions, restrictive lungs disease
- concern for cervical spine positioning, airway, and respiratory system
- awake fiberoptic intubation
6
Q
tourniquet positioning and application
A
- should cover <50% of the extremity
- padded
- off neurovascular bundles
- exsanguination prior to inflation with esmark
- 90-100 mmHg above SBP
7
Q
tourniquet hazards - neurological
A
- abolish SSEP at 30 min
- pain at 60 min
- neuropraxia at 120 min
- nerve injury at edge of tourniquet
8
Q
tourniquet hazards - muscle
A
- cellular hypoxia at 2 min
- creatinine value decrease
- cellular acidosis
- endothelial capillary leak at 120 min
9
Q
tourniquet - systemic effects
A
- 300-500 cc blood added to circulation
- increased systemic and pulmonary pressures
10
Q
tourniquet deflation
A
- fall in core temperature
- metabolic acidosis
- increase ETCO2
- decrease in pulmonary and systemic BP
- fall in MVO2
*takes 20 min for effects to resolve if 1 hour of tourniquet time
11
Q
tourniquet safety
A
- do not exceed 2 hours
- nerve damage after 4 hours
- muscle power reduced for a week after 3 hours
12
Q
bier block steps
A
- iv
- double tourniquet
- exsanguination with Esmark
- inflate cuff
- inject local anesthetic
- inflate distal cuff, after 20 min can reinflate distal cuff and deflate proximal cuff
- deflate cuff in stages
- remove iv and apply pressure
13
Q
complications from intravenous regional anesthetic
A
- hematoma
- systemic toxicity of local anesthetic
- engorgement of the extremity
- ecchymosis and subcutaneous hemorrhage
14
Q
positioning risks/hazards - beach chair
A
- cervical neck injury due to dislodgement of head from holder
- inadvertent extubation by surgical team
- brachial plexus injury on contralateral side
- CVP, MAP, PAP, CO, venous return decrease
- CPP decreases and autoregulation is hindered
- PVR, TPR increased but blunted by volatile anesthetics
15
Q
positioning advantages - beach chair
A
- reduced rate of brachial plexus injuries
- better respiratory mechanics
- excellent access to shoulder
- weight of arm distracts shoulder joint
