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Patient Positioning Flashcards

1
Q

Supine Position:

  1. Indications
  2. Risks
  3. Cardiovascular Changes
  4. Respiratory Changes
  5. Cranial Changes
A
  1. Provides easy access to airway, IVs, less physiological changes
  2. Pillow under head; avoid felxion or extension due to brachial plexus stretch; arms abducted <90 degrees, supinated; slight leg flexion (watch DVTs if pillow under knees)
  3. Minimal overall; Will have initial increased VR, then increases parasympathetic compensation ( 🔽 HR, PVR) Eventual reduced VR due to pooling; careful for IVC compression in pregnant, ascites, obese
  4. FRC decreases 800ml due to diaphragm displacement;
  5. Minimal; auto regulation tight
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2
Q

Trendelenburg Position:

  1. Indications
  2. Risks
  3. Cardiovascular Changes
  4. Respiratory Changes
  5. Cranial Changes
A
  1. Can prevent air embolism; short term hypotension tx; upward displacement of abd cavity contents
  2. Brachial plexus injury; shoulder brace lateral over acromium process
  3. Increases VR up to 1L; baroreceptors activates; only use short term for shock
  4. Decreases compliance, PIP, FRC; VQ mismatch at apex (perfusion>ventilation); risk of aspiration
  5. Increases ICP; intraocular pressure
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3
Q

Reverse Trendelenburg:

  1. Indications
  2. Risks
  3. Cardiovascular Changes
  4. Respiratory Changes
  5. Cranial Changes
A
  1. Enhances view of upper abd contents (laparoscopy, cholesystectomy)
  2. Watch for foot drop and excessive flex ion
  3. Reduces VR; preload, CO, BP; compensatory mech blunted by anesthetics
  4. Ventilation easier; increases FRC and diaphragmatic excursion
  5. Blood flow decrease, ICP down 20%
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4
Q

Lithotomy Position:

  1. Indications
  2. Risks
  3. Cardiovascular Changes
  4. Respiratory Changes
  5. Cranial Changes
A
  1. GYN, GU, rectal procedures
  2. Avoid flexion beyond 110; common perineal nerve most commonly damaged lower extremity nerve
  3. Leg elevation increases VR; perfusion change 2 mmHg per every 2.5cm above heart
  4. Decreases diaphragm excursion; ⬇️ compliance, TV,
    VC
  5. Transient increase in blood flow
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5
Q

Prone Position:

  1. Indications
  2. Risks
  3. Cardiovascular Changes
  4. Respiratory Changes
  5. Cranial Changes
A
  1. Usually cranial surgery; Have Wilson frame (free-hanging abd); prepare pt on stretcher before trans
  2. Neck alignment, pressure on eyes, nose; corneal abrasion/pressure, blindness; line/ET displacement;
  3. Thoracic outlet syndrome; IVC and aortic compression hypotension; ⬇️ CO and BP, especially on initial move
  4. VQ mismatch; post vent>perf; ant perf>vent; ⬆️ PIP,
    work of breathing
  5. Obstruct venous outflow if head turned; increases ICP
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6
Q

Most commonly damaged nerve

A

Ulnar

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7
Q

Main nerves of the arm

A

Ulnar, medial, radial

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8
Q

Common Brachial Plexus Injury Mechanisms (5 items)

A
  1. Neck extension
  2. Arm abduction >90
  3. Arm falling of table
  4. Depressed shoulders (prone/reverse Tren)
  5. Compression against thorax (lateral)
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9
Q

Radial Nerve Compression:

  1. Common causes
  2. Symptoms
A
  1. Surgical retractors, ether screen, BP inflation

2. Loss of extension of forearm, wrist drop (loss of hand extension), loss of sensation in lateral arm

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10
Q

Ulnar Nerve Compression:

  1. Common causes
  2. Symptoms
A
  1. Most common injury; severe elbow flexion; compression against bed; BP inflation
  2. Loss of grip, inability to abduct or feel 4/5th finger; atrophy (claw hand)
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11
Q

Common Peroneal Nerve

  1. Location/Innervation
  2. Injury Mechanism
  3. Symptoms
A
  1. Branch of sciatic, innervates outer calf; most common lower extremity injury
  2. Compression of lateral knee (lithotomy or lateral)
  3. Foot drop; inability to evert foot or dorsiflex toes
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12
Q

Popliteal Nerve Injury

  1. Location/Innervation
  2. Injury Mechanism
A
  1. Branch of sciatic that innervates back of knee

2. Compression behind knee (lithotomy)

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13
Q

Sciatic Nerve

  1. Location/Innervation
  2. Injury Mechanism
  3. Symptoms
A
  1. Runs from buttock through lower limb
  2. Excessive rotation of hips; pressure on sciatic notch (posterior buttocks)
  3. Weakness or paralysis of muscles below knee; foot drop
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14
Q

Femoral Nerve Injury

  1. Location/Innervation
  2. Injury Mechanism
  3. Symptoms
A
  1. Runs length of internal thigh
  2. Compression at pelvic brim; excessive angulation/abduction of thighs and external rotation (lithotomy)
  3. Loss of flexion at hip; loss of extension of knee; decreased thigh sensation
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15
Q

Saphenous Nerve Injury

  1. Location/Innervation
  2. Injury Mechanism
  3. Symptoms
A
  1. Medial aspect of the thigh and lower leg; branch of
    femoral nerve
  2. Compression of medial aspect of leg against support bar (lithotomy)
  3. Parathesia medial and antemedial part of calf
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16
Q

Lower Compartment Syndrome

  1. Occurrence
  2. Symptoms
  3. Treatment
A
  1. Typically long lithotomy/lateral cases (>2-3 hours)
  2. Ischemia, edema, rahbdomyolysis
  3. Fasciotomy
17
Q

Thoracic Outlet Syndrome

  1. Definition
  2. Test
A
  1. Poor circulation in vessels between upper extremities and trunk
  2. Extend pt hands over head for 1 minute; check perfusion
18
Q

Lateral Position:

  1. Indications
  2. Risks
  3. Cardiovascular Changes
  4. Respiratory Changes
  5. Cranial Changes
A
  1. Kidney, lung shoulder, hip surgery
  2. Neutral head support, pressure on dependent eye/ear
    Axillary Roll placed lower axilla; knee padding
  3. Minimal; no change in CO unless VR obstructed; BP will be different in arms
  4. VQ mismatch
  5. Minimal unless extreme flexion
19
Q

Lateral Position VQ Mismatch:

  1. Awake/Spontaneous Breathing
  2. Anesthetized/ Spontaneous Breathing
  3. Anesthetized/ Mechanical Ventilation
A
  1. Dependent lung: better perfused and ventilated (lower lung volumes)
  2. Dependent lung: better perfused, Nondependent lung: better ventilated (VQ Mismatch)
  3. Dependent lung: overperfused; Nondependent lung: overventilated (worse VQ mismatch)
20
Q

Sitting Position:

  1. Indications
  2. Risks
  3. Cardiovascular Changes
  4. Respiratory Changes
  5. Cranial Changes
A
  1. Cranial, shoulder, humeral procedures
  2. Avoid excessive neck flexion (2 FB between mandible and sternum); flexion can cause venous congestion, cervical nerve stretch, tongue swelling; flex knees
  3. Pooling of blood in LE; hypotension; HR and SVR usually blunted by anesthetics; check BP often
  4. Lung volumes and capacities increased; compliance increases; work of breathing decreases
  5. ICP and cerebral blood flow decreased
21
Q

Venous Air Embolism

  1. Risk
  2. Symptoms
  3. Detection
A
  1. Anytime surgical field above level of heart
  2. Heart tone murmurs, dysrhythmias, decreased ETCO2
  3. TEE or prerecordial Doppler
22
Q

Venous Air Embolism Treatment (5 items)

A 
1. Flood surgical field with NS, apply wax to bones, close
    any open vessels
2. D/C N20
3. Place on 100% and PEEP
4. T-berg position
5. Aspirate air via CVC

Positioning (6 decks)

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