Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1: Intro to Anesthesia > Positioning > Flashcards

Positioning Flashcards

1
Q

Positioning is shared responsibility, but ultimately positioning is determined by?

A

surgeon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is CRNA’s primary responsibility (3)?

A

protect aw, vascular access and promote homeostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Are all PNI preventable?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which PNI most common? Second most common? Most common LE PNI?

A

ulnar nerve, brachial plexus close second, sciatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Supine is also called?

A

dorsal decubitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is most common operative position?

A

supine/dorsal decubitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Arms should never be abducted > ____ degrees?

A

90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Arms should always be supinated or pronated? Or?

A

supinated, palms up

at side, palms in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can be injured if arms are abducted > 90 and pronated?

A

brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can the lumbar be supported in supine position? (3)

A

slight flexion hips/knees, pillows under knees, elastic compression stockings/SCDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why does the lumbar need to be supported in surgery and supine position?

A

ligaments of vertebral column relax w/ anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can cause brachial plexus injuries in surgery? (4)

A

abduction of arms >90, compression of neck, shoulder braces/pads, cardiac surgery - instruments that open chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What injury can result if arms are pronated and why?

A

ulnar injury, d/t compression of cubital tunnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are possible complications of supine position? (5)

A

pressure alopecia, backache, aortocaval compression syndrome, skin breakdown/ulcers, circulatory compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is aortocaval syndrome?

A

compression of abd aorta and IVC in pregnant women from lying flat on back, causes hypotension and fetal compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What variation on supine can help alleviate low back pain?

A

lawn chair position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the effects of trendelenburg position? Increases, decreases, why?

A

increased venous return: increased preload, increased venous return increased ICP/decreased CPP - vascular congestion, increased intraocular pressure, increased PIP

abd contents/diaphragm moves cephalad, compresses lungs: decreased FRC, decreased pulmonary compliance, r/o endobronchial intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Fluid shifts in Trendelenburg can cause what complication? And it can cause what?

A

Edema: aw, tongue, pharanyx, face, sclera

Can cause aw patency issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If worried about effects of Trendelenburg position on aw patency what interventions can you perform? (2)

A

check for cuff leak, listen to lung sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the anesthetic concerns of Trendelenburg? (7)

A

sliding, alt. cardio/pulm function, PNI, aw edema, compartment syndrome, regurg/asp, ETT migration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How can you lower the risks of Trendelenburg? (8)

A

anti skid pads, appropriate padding - face, confirm ett, conservative use of fluids, post-op O2, OGT/suctioning, ensure patent IVs, vent modes (OC vs VC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What surgeries are facilitated by reverse Trendelenburg? Why?

A

upper abd, head and neck, shoulder, intracranial

promotes venous drainage, decreases blood/bleeding, movings abd contents caudad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What surgeries are facilitated by lithotomy?

A

GYN, rectal, urology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some concerns of lithotomy position? (5)

A

watch for crush finger injuries, raising/lowering legs (do it at the same time, slowly), PNI, intubation difficulties, ask pt to position themselves by moving down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some possible PNI and causes in lithotomy position?

A

candy cane - common peroneal - compression of lateral head of fibula, femoral, sciatic

knee crutch - popliteal, tibial nerve common peroneal nerve

excess hip flexion: obturator, lateral femoral cutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are CV/respiratory consequences of lithotomy? And why?

A

displacement of abd contents cephalad, legs elevated - increased venous return:

decreased lung compliance, decreased Tv, increased PIP, increased CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What LE complication can occur in lithotomy position and why?

A

compartment syndrome, d/t inadequate extremity perfusion, extensive rhabdomylosis - increased tissue pressure, occurs from long surgical procedures > 2-3, people with low BMI and smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What pt factors increases risk of complications in lithotomy position? (3)

A

low BMI, smoking, prolonged surg. ( > 2-3 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some risk reduction strats for lithotomy position? (4)

A

attention to hands/fingers, intraoperative repositioning, lower legs occasionally, avoiding excessive hip flexion/abduction,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What types of surgeries use lateral decubitus position?

A

thorax, kidney, shoulder, ortho, spinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When should eyes be taped?

A

after intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is an anesthetic concern in lateral decubitus position? Intervention and why its done.

A

dependent side, place axillary roll, just inferior to axilla, 7th/9th rib

avoids compression of axillary neurovasc structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What intervention helps monitor circulation in dependent arm?

A

check pulse in dependent arm via pulse ox

34
Q

How will NIBP differ in dependent arm?

A

increased

35
Q

What LE PNI can occur in lateral decubitus position and intervention to prevent it?

A

common peroneal, saphenous

pad knees

36
Q

What are pulm. consequences of lateral decubitus position? Why?

A

V/Q mismatch d/t dep lung better perfused, worse ventilated; non-dependent lung worse perfused, better ventilated

37
Q

Contrast high V/Q mismatch vs low.

A

High - lots of ventilation, low/little perfusion. High O2. Aka deadspace.

Low - lots of blood flowing, but little to no ventilation. Low O2. Aka shunting.

38
Q

Why is the dependent lung better perfused?

A

gravity

39
Q

Compare contract differences in anesthetized vs not anesthetized pts lungs in lateral positioning.

A

awake/spont breathing: dependent lung better V and Q but lung volumes are decreased (Tv, FRC)

anesthetized/spont breathing: nondependent lung better V, dependent lung better Q (mismatch)

anesthetized/mech. vent.: nondependent lung over-V and dependent lung over-Q (worse mismatch)

40
Q

Prone positioning is also called?

A

ventral decubitus

41
Q

When pt is going to be in prone positioning, where should the pt be intubated?

A

stretcher (also when foley, temp probe, IV done, bite block placed)

42
Q

What should remain connected to pt and where when proning pt? Why?

A

pulse ox, on dependent arm

43
Q

Whats the last thing that is disconnected before proning pt?

A

ett

44
Q

When proning a pt what is the job of the CRNA?

A

coordinating movement of head

45
Q

Describe how pt’s legs, face, arms and abd should be positioning in prone.

A

legs: flexed, padded, compression hose - venous pooling
face: down or to the side, pillow, neck natural alignment
arms: tucked or above head < 90 degrees - prevents brachial plexus injury, padded elbow prevents ulnar nerve injury
abd: avoid pressure - causes decreased FRC, pulm. compliance, increased PIP, use bolsters or firm rolls clavicle to iliac crests

46
Q

Immediately after a pt is proned what should be done next? (4)

A

reconnect vent, reapply monitors, check ETT (etCO2, lung sounds, Tv, PIP), check alignment of head and neck

47
Q

What are Mayfield pins? Who is responsible for them? What are some concerns?

A

for cranial/cervical surgeries, ensures correct alignment of pt and that they do not move during surgery. surgeon responsible for count when moving.

make sure no metal parts are putting pressure on eyes, nose or chin, and not compressing neck.

48
Q

What is the significance of abdominal pressure in prone positioning?

A

external pressure on abd elevates intrathoracic and intraabd pressure. increased pressure on IVC, compressed IVC -> decreased venous return, decreased CO.

significant bc excess bleeding in surgical field may occur but not be noticed

49
Q

What is perioperative visual loss, how does it occur, things to be mindful of (5)?

A

painless vision loss after surgery, ischemic optic neuropathy (ION) and central retinal artery occlusion (CRAO) - from direct, external pressure to face during prone positioning, fluid shift.

mindful of: hypotension, anemia, increased crystalloid use, blood loss, long duration

50
Q

What respiratory effects does prone positioning have?

A

Improved V/Q mismatch

51
Q

What cardiovascular affects occur w/ proning a pt?

A

IVC/aorta compressed, leads to hypotension. Also, venous pooling in LE leads to hypotension. Both lead to decreased preload, CO, BP.

52
Q

What affects can proning have on cerebral blood flow

A

turning head obstructs venous drainage leading to increased cerebral volume and increased ICP. excess flexion/turning causes obstruction to vertebral artery flow.

spinal cord injury can also result from stretch.

53
Q

What equipment can help lower pressure on the abd during proning?

A

Wilson, Jackson, Allen frames

54
Q

Genitalia should be free of ______ during proning.

A

Pressure

55
Q

Populations that are difficult to prone (3)

A

obese, resp. compromise, pts w/ difficulty repositioning

56
Q

Sitting position is used it what types of surgeries? And why?

A

post cerv spine, post fossa d/t excellent surgical exposure, decreased blood in surgical field, reduced blood loss, better mobilization of shoulder

57
Q

What are some anesthetic advantages of sitting position? (3)

A

aw access, reduced facial swelling, improved ventilation

58
Q

Describe sitting positioning’s arms, head, legs.

A

head: pinned or taped, arms: slight elevation of shoulders, padded, knees: slightly bent - reduce sciatic nerve stretching, feet: supported and padded

59
Q

What are the risks in sitting position? (7)

A

VAE, quadriplegia, spinal cord infarction, hemodynamic instab. - stroke/death, pneumocephalus - air/gas in head, macroglossia - d/t pressure on tongue, may need trach, PNI

60
Q

What are the hemodynamic effects of sitting position?

A

Pooling of blood in LE, causes hypotension from reduced venous return, reduces CO.

61
Q

What interventions can you do to mitigate hemodynamic effects of sitting position? (5)

A

incremental positioning, IVF, vasopressors, adjusting anesthesia (fewer sedatives, nerve block instead, or TIVA), SCDs/TED hose

62
Q

What are some anesthetic concerns for the head and neck in sitting position?

A

hyperextension of neck leading to cervical injuries.

flexion causes: impedance of blood flow - leads to hypoperfusion or venous congestion in brain, blocking ett - impedance to breathing, pressure on tongue, midcervical tetraplegia - ischemia to spinal cord

63
Q

Beach chair position is used for what type of surgery?

A

shoulder surgery

64
Q

A 1 cm rise causes a _______ drop in BP.

A

0.75 mmHg drop (a MAP of 65 in the arm is 50 in the head, aka a 20 cm rise)

65
Q

When can a VAE happen?

A

any time surgical site above level of heart

66
Q

What are signs of VAE? (8) What about if pt is awake, spont breathing?

A

wind mill murmur, dysrhythmias, hypotension, desaturation, decreased etCO2, N2 in exhaled gas, circ compromise, cardiac arrest

dyspnea, coughing, breathless, light headed, chest pain, feeling of doom

67
Q

How much air is lethal in VAE?

A

200-300 mL

68
Q

What does a VAE cause?

A

right heart failure

69
Q

What EKG changes will you notice with VAE? (3)

A

kink in T wave, tachy dysrhythmias, ischemia

70
Q

How to monitor for VAE? (3)

A

precordial steth, doppler, TEE

71
Q

Whats treatment for VAE? (11)

A

flood surgical field with NS, apply wax to bony edges, close open vessels, D/C N2O, place pt on 100% O2, PEEP, trendelenburg, aspirate air from RA w/ catheter, vasopressors (dobut/norepi - anything that does not increase vasc resistance), hyperbaric O2, CPR/resuscitation

72
Q

What are some examples of high risk surgeries for VAE?

A

sitting crani, posterior fossa/neck, laprascopic surg, total hip arthroplasty, C-section, central line placement, craniosynotosis

73
Q

Brachial plexus: where is it and how can it be injured?

A

Network of nerves in shoulder, travels through cervical vertebrae and through axillary fascia.

Injured by kink/stetch/compression: abducting > 90, compressing clavicle or soft tissue of axilla, neck extension, head turning side to side, arm board falling off table, shoulder braces, sternal retractors, compression against thorax

74
Q

Whats the deficit if brachial plexus is injured? (3)

A

limp/paralyzed arm, lack of muscle control in shoulder/arm/hand/wrist, lack of sensation in arm or hand

75
Q

Ulnar nerve: where is it and how can it be injured?

A

Groove between olecranon of ulna and medial epicondyle of humerus.

Injured from compression of nerve in cubital groove in elbow, stretch injury from extreme flexion, compression against bed/IV pole, misplaced BP cuff, dislocation over medial epicondyle w/ pronation causing stretching

76
Q

What deficits w/ ulnar nerve injury?

A

inability to abduct/oppose 5th finger (touch thumb), loss of grip strength, loss of sensation of 4th and 5th fingers, claw hand - from atrophy of intrinsic muscle of hand (chronic injury, not right after surgery)

77
Q

How does a radial nerve injury result and what are the deficits?

A

external compression of nerve on lateral aspect of humerus against: surgical retracts, ether screen, mismatched arm board, repeat BP inflation, sternal retractor.

loss of extension of forearm, weak supination, loss of extension of hand (WRIST DROP) and fingers, loss of sensation of posterior forearm and part of hand

78
Q

Common peroneal nerve: hows it injured and what are the deficits?

A

branch of sciatic nerve, runs along lateral aspect of knee. injured from compression of lateral aspect of knee against stirrup or in lateral decubitus position.

deficits are: FOOT DROP, inability to evert foot, loss of dorsal extension of toes (no sensation)

79
Q

Sciatic nerve: hows it injured and what are the deficits?

A

excessive external rotation of hips, hyperextension of knee, pressure in sciatic notch from stretching

deficits: weakness/paralysis of muscles below knee, numbness in foot and lateral half of calf, FOOT DROP

80
Q

Femoral nerve: hows it injured and what are the deficits?

A

injured by compression at pelvic brim by retractor or excessive angulation of thigh and external rotation of hips

deficits: loss of flexion of hip, loss of extension of knee, decreased sensation superior thigh

81
Q

Saphenous nerve injury: hows it injured and what are deficits?

A

medial aspect of lower leg compressed against support bar

deficit: paresthesis medial and antemedial side of calf

1: Intro to Anesthesia (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions